[Pathomorphology, diagnosis and treatment of "hangman's fractures"]

In a retrospective study diagnostic procedures and outcome of treatment were evaluated in 33 patients with traumatic spondylolisthesis of the axis (Hangman's fracture) who were treated in our department between 1986 and 1999. There were 18 men and 15 women with an average age of 41 (17-88) years. The cause of the injury was in 23 cases an accident as a driver of a car, in 2 cases an accident with a bike, 2 patients had an accident as a pedestrian. 5 patients fell on their head and 1 patient was hit by a beam. In 15 cases there were relevant accompanying injuries. To assess the stability of the injury, a subtle radiological examination was performed including functional X-rays. After introduction of the MRI and increasing experience with the method as a standard procedure in clinical practice it was used instead of functional X-rays to get a direct image of the involvement of the discoligamental structures.17 patients with stable lesions were treated conservatively, 15 with a Minerva-cast, 2 with a halo-jacket. One polytraumatized patient had temporary immobilization with a stiff-neck. 16 patients with discoligamental instability C2/3 were treated operatively by Robinson-spondylodesis with additional anterior plating. In one case an additional posterior fusion was necessary. After 6-8 weeks all of the conservative treated patients achieved solid bony consolidation. The patients operated on did so as well within 6 to 8 weeks. Two polytraumatized patients died. 18 of the 31 surviving patients were free of pain. 12 patients complained of pain or tension of the cervical muscles during physical stress. 1 patient suffered of paresthesia of the ulnar left hand. Average duration of hospital stay was 12,9 days (1-47). All working people returned to their job. Differences in the outcome of the conservative and the operative treatment group could not be seen. We derive from these results that Hangman's fractures, mostly caused by a hyperextension trauma, achieve solid bony fusion by conservative treatment in most of the cases. The Minerva-cast has proved its capability. In cases of instable luxation fractures including tearment of the anterior longitudinal ligament and affection of the intervertebral disc C2/3 we suggest operative stabilization. We prefer the modified Robinson-spondylodesis with additional anterior plating which proved its value as a method achieving solid bony fusion combined with low rate of complications.