Hangman's fracture: radiologic assessment in 27 cases

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Radiology

Background:

• Traumatic spondylolisthesis of C-2, or hangman's fracture, is often considered a hyperextension injury with minimal neurologic risk due to neural canal decompression.
• This common perception may underestimate the potential for associated injuries and complications.

Purpose of the Study:

• To retrospectively analyze radiographic findings in patients with hangman's fractures.
• To evaluate the diagnostic utility of computed tomography (CT) scans in assessing C-2 fractures.
• To determine the incidence of neurologic sequelae and associated injuries in hangman's fractures.

Main Methods:

• Retrospective review of radiographic data from 27 patients diagnosed with traumatic C-2 spondylolisthesis over 24 months.
• Analysis of lateral cervical spine X-rays and computed tomography (CT) scans for 21 patients.
• Assessment of fracture patterns, neurologic deficits, and associated injuries.

Main Results:

• Computed tomography (CT) scans offered superior fracture delineation compared to plain radiographs, providing crucial additional detail in 24% of cases.
• A significant percentage of patients (26%) experienced initial neurologic sequelae.
• Associated injuries were common, with 26% of patients having C-1 ring disruption and one case involving vertebral artery injury and cerebellar embolization.

Conclusions:

• Hangman's fractures are associated with a higher incidence of neurologic sequelae and C-1 ring disruption than previously recognized.
• CT imaging is essential for comprehensive evaluation of hangman's fractures, aiding in the detection of associated injuries.
• Fractures extending into the transverse foramina necessitate careful evaluation for vertebral artery injury, potentially requiring angiography and anticoagulation.