Traumatic spondylolisthesis of the axis

Area of Science:

• Forensic pathology
• Orthopedic surgery
• Traumatology

Background:

• Hanging, an ancient execution method, often resulted in death by asphyxiation.
• Autopsy studies in the late 19th century identified cervical spine lesions.
• Experimental work in 1913 linked specific knot placement to traumatic spondylolisthesis of C2.

Purpose of the Study:

• To review the historical context and biomechanics of hangman's fractures.
• To differentiate between judicial hanging injuries and similar civilian trauma.
• To propose a more accurate terminology for the injury.

Main Methods:

• Historical review of autopsy and experimental studies.
• Analysis of injury mechanisms in judicial hanging and civilian accidents.
• Literature review of reported cases and expert opinions.

Main Results:

• Judicial hanging, particularly with the knot under the chin, causes traumatic spondylolisthesis of the axis (C2).
• Civilian injuries, like those from car accidents, can mimic hangman's fractures due to hyperextension.
• Garber suggested traumatic spondylolisthesis of the axis as a more precise term.

Conclusions:

• The term "hangman's fracture" originated from observed similarities between judicial hanging and civilian injuries.
• Understanding the distinct biomechanical forces is crucial for accurate diagnosis and terminology.
• Traumatic spondylolisthesis of the axis accurately describes the C2 vertebral injury regardless of cause.