Surgical Management of the Hangman’s Fracture in the Twelve Cases: Case Series

Abstract

Objective: Hangman's fracture is a condition characterized by anterior displacement of C2 upon C3 with a fracture in the C2 where the neural arch attaches to the vertebral corpus as a result of axial loading of the head accompanying hyperextension. Material and Methods: From January 2015 to January 2022, analysis retrospectively included 12 patients operated by hangman’s fracture. The lesions were considered to be a hangman’s fracture after computed tomography findings. The clinical condition was classified on the basis of American Spinal Injury Association scale and visual analog scale. All patients underwent C2-3 posterior fusion. All patients had at 6 and 12 months follow-up cervical computed tomography, which were used to assess bony union, final displacement, and angulation. Results: 5 of the patients were males and 7 females with the age range of 22-82 (mean age 49). The cause of trauma was in vehicle accident in 4 patients, falling from a height in 6 patients, and falling after slipping in the bathroom in 2 patient. All patients complained of neck pain. Except for 2 patients with upper extremity paralysis and spastic tetraparesis, 10 patients had no neurological deficit. According to the Levine and Edwards typical hangman’s fracture classification, 7 had Type II fractures, while one patient had Type III fractures. According to the Li-Wang atypical hangman’s fracture classification, 4 were Type B. Conclusion: Radiological evaluation and subsequent classification are very important in management. Posterior C2-3 fusion is a very effective surgical way.