Postmortem multislice computed tomography (pmMSCT) imaging of hangman's fracture

First described in 1965, avulsion of the neural arch from the vertebral body of the axis (C2) as a sequel to violent and rapid hyperextension of the head was termed hangman's fracture because of its similarity to the injury observed after judicial hanging. Since diagnosing such a fracture at autopsy is difficult because of its anatomic position, accurate determination of features of a hangman's fracture in cases of non-judicial hanging has not been systematically elucidated. We performed a prospective autopsy study visualizing hangman's fractures in 32 cases of hanging using postmortem multislice computed tomography (pmMSCT). A hangman's fracture with a fracture of the vertebral arch adjacent to the C2 vertebral body was only detected in one case (3.1 %). In this case a rarely observed longer drop with a lateral knot was used. Although a hangman's fracture was invariably observed bilaterally in previously reported cases, our case revealed a unilateral fracture at the side corresponding to the location of the knot. Out of the three types of hangman's fracture, pmMSCT is especially useful for detecting type 1 (nonangulated, undisplaced C2 with a normal disk at C2/C3). Also, pmMSCT is superior to conventional radiography in diagnosis, especially when the fracture is extending into the transverse foramen. In conclusion, pmMSCT imaging is useful for detecting hangman's fracture in hanging cases. Accumulating more evidence through pmMSCT will allow clarification of the actual incidence and circumstantial findings of hangman's fracture that have been controversially debated for many decades in the forensic community.