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Updated: Jul 17, 2026
Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
Hangman's fracture: a biomechanical comparison of stabilization techniques
Neil Duggal1, Robert H Chamberlain, Luis E Perez-Garza
1London Health Sciences Centre, London, Ontario.
Study Design:
In vitro biomechanical flexibility experiment studying 5 sequential conditions.
Objective:
To determine the biomechanical differences among 3 fixation techniques after a simulated hangman's fracture.
Summary Of Background Data:
Type II hangman's fractures are often treated surgically with a C2-C3 anterior cervical discectomy, fusion, and plating. Other techniques include direct fixation with C2 pars interarticularis screws or posterior C2-C3 fixation connecting C2 pars screws to C3 lateral mass screws.
Methods:
Seven cadaveric specimens (Oc-C4) were tested intact, after a simulated hangman's fracture, and after each fixation technique. Flexion, extension, lateral bending, and axial rotation were induced using nonconstraining torques while recording angular motions stereophotogrammetrically.
Results:
Direct screw fixation reduced motion an average of 61% +/- 13% during lateral bending and axial rotation compared to the injured state (P < 0.007). However, instability remained during flexion and extension. Posterior C2-C3 rod fixation provided significantly greater rigidity than anterior plate fixation during lateral bending (P < 0.008) and axial rotation (P < 0.04).
Conclusions:
Direct fixation of the pars ineffectively limits flexion and extension after a Type II hangman's fracture. If pars screw fixation can be achieved, posterior C2-C3 fixation more effectively stabilizes a hangman's fracture than anterior cervical plating.
