Posterior short-segment fixation and fusion in unstable Hangman's fractures

A retrospective study. OBJECTIVE.: To introduce the method of C2-C3 posterior short-segment fixation and fusion in unstable Hangman's fracture and to evaluate the clinical effects.

Hangman's fracture can be managed by closed reduction and immobilization. However, surgery is usually preferable in highly unstable cases and in rigid arthrodesis failure. The outcome of surgical treatment for unstable Hangman's fracture has not been thoroughly investigated.

Thirty-five patients with unstable Hangman's fracture were treated using C2-C3 posterior short-segment fixation and fusion. Twenty-six cases used C2-C3 short-segment pedicle screw fixation. Nine cases used both C2 pedicle screw and C3 lateral mass screw short-segment fixation and fusion. C-arm fluoroscopy was used for the whole procedure. RESULTS.: All patients were observed for an average of 44 months, ranging from 12 to 78 months. There was no screw loosening or breakage, nor was there any spinal cord or vertebral artery injury intraoperatively. A total of 140 screws were placed, with 70 screws inserted into the C2 pedicle, 52 into the C3 pedicle, and 18 into the C3 lateral mass. Computed tomography scans indicated 9 screws were placed too close to the vertebral artery canal in C2, and 12 screws were too close to the canal in the C3 pedicle, all without clinical consequences. C3 lateral mass screws were placed successfully. Neurologic status improved from C and D to E in all 8 cases. Static and dynamic films demonstrated that fusion was achieved in all cases 6 months after surgery. No graft or plate-related complications were observed in any patients during the entire follow-up period.

C2-C3 posterior short-segment fixation and fusion is an effective method for the management of unstable Hangman's fracture, proving its value as a technique for achieving solid bony fusion combined with a low rate of complications.