Unstable Hangman's fracture: Anterior or posterior surgery?

Patel, Jwalant Yogesh Kumar; Kundnani, Vishal; Kuriya, Suraj; Raut, Saijyot; Meena, Mohit

doi:10.4103/jcvjs.jcvjs_112_19

Cited by 14 publications

(6 citation statements)

References 28 publications

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“…8 In addition to the authors reporting that the neck brace and halo are superior to surgery, there are articles in the literature suggesting early surgical treatments as soon as a fracture is encountered. [9][10][11] In addition, considering that neurological deterioration may occur in hangman fractures, patients should be followed up with strict neurological examination and observation. In Type I, which is a stable fracture, the patient can be mobilized early with an average of 2.5-3 months of immobilization and segment immobilization.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of the Hangman's Fracture in the Twelve Cases: Case Series

AKŞAN¹,

Seçer²

2023

Turkiye Klinikleri J Med Sci

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Hangman's fracture is a condition characterized by anterior displacement of C2 upon C3 with a fracture in the C2 where the neural arch attaches to the vertebral corpus as a result of axial loading of the head accompanying hyperextension. Material and Methods: From January 2015 to January 2022, analysis retrospectively included 12 patients operated by hangman's fracture. The lesions were considered to be a hangman's fracture after computed tomography findings. The clinical condition was classified on the basis of American Spinal Injury Association scale and visual analog scale. All patients underwent C2-3 posterior fusion. All patients had at 6 and 12 months follow-up cervical computed tomography, which were used to assess bony union, final displacement, and angulation. Results: 5 of the patients were males and 7 females with the age range of 22-82 (mean age 49). The cause of trauma was in vehicle accident in 4 patients, falling from a height in 6 patients, and falling after slipping in the bathroom in 2 patient. All patients complained of neck pain. Except for 2 patients with upper extremity paralysis and spastic tetraparesis, 10 patients had no neurological deficit. According to the Levine and Edwards typical hangman's fracture classification, 7 had Type II fractures, while one patient had Type III fractures. According to the Li-Wang atypical hangman's fracture classification, 4 were Type B. Conclusion: Radiological evaluation and subsequent classification are very important in management. Posterior C2-3 fusion is a very effective surgical way.

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Section: Discussionmentioning

confidence: 99%

“…However, surgery should be performed first in patients with intracanal disc and bone fragments. 10,11 Unstable fractures can be effectively managed with both anterior and posterior approaches with comparable clinical-radiological outcomes. 12 Traction should not be applied in Type IIA fractures as it may increase the deformity.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of the Hangman's Fracture in the Twelve Cases: Case Series

AKŞAN¹,

Seçer²

2023

Turkiye Klinikleri J Med Sci

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“…2,9 Direct repair of the pars interarticularis fracture with a transpedicular screw across the fracture line has the advantage of preserve segment motion. 2,13 However, traditional transpedicular screw fixation for Hangman fracture has several disadvantages. First, reduction cannot be easily achieved with a traditional transpedicular screw because the direction of the screw hole is usually not perpendicular to the fracture line, which can lead to loss of reduction during compression.…”

Section: Discussionmentioning

confidence: 99%

Fijación con tornillo transpedicular en C2 en el tratamiento de fractura de Hangman tipo III de Levine-Edwards: una opción para preservar el movimiento

Tafur-Grandett,

Ramos-Hinojosa,

Olivas-Campos

2023

Cir Columna

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Introduction: bilateral pars interarticularis fracture of C2 due to traumatic spondylolisthesis accounts for 4 to 7% of cervical fractures and 20 to 22% of C2 fractures. The choice of surgical approach remains controversial; available options include C2-C3 ACDF, C2-C3 posterior fusion, C2 transpedicular screw alone, and 360 o approach. Case presentation: male, 60 years old, after a rollover car accident, presents with neck pain VAS 10/10, radiculopathy in right C2-C5, strength 3/5 on the MRC Scale in right C4-C5, right bicipital reflex 1/+. CT with Hangman Type III fracture. We performed external cervical reduction with Mayfield head support, posterior cervical approach and transpedicular fixation of C2, polyaxial trans facet screws in C3 and lateral titanium bars. Conclusiones: Hangman type III fractures must be diagnosed promptly due to the risk of neurological injury. These should be treated with fixation, if possible, with a transpedicular screw at C2, which is an excellent option for reduction and stabilization of the fracture, maintenance of cervical alignment and preservation of ranges of motion. RESUMENIntroducción: la fractura bilateral de la pars interarticularis de C2 por espondilolistesis traumática representa 4 a 7% de las fracturas cervicales y 20 a 22% de las fracturas de C2. La elección del abordaje quirúrgico sigue siendo controvertida; las opciones disponibles incluyen ACDF C2-C3, fusión posterior C2-C3, tornillo transpedicular de C2 solo y abordaje 360 o . Presentación del caso: masculino, 60 años de edad, tras accidente automovilístico tipo volcadura, cursa con cervicalgia EVA 10/10, radiculopatía en C2-C5 derecha, fuerza 3/5 en escala MRC en C4-C5 derecho, reflejo bicipital derecho 1/+. TC con fractura de Hangman tipo III. Hicimos reducción cervical externa con apoyo de cabezal de Mayfield, abordaje cervical posterior y fijación trasnpedicular de C2, tornillos transmacizo facetario en C3 y barras laterales de titanio. Conclusions: las fracturas de Hangman tipo III deben diagnosticarse oportunamente debido al riesgo de lesión neurológica. Estas deben tratarse con fijación, si es posible con tornillo transpedicular en C2, que es una excelente opción

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“…Non-operative treatment with immobilization either with cervical collar or halo-vest is choice for stable hangman's fractures or for the patients with surgical contraindications [21][22][23]. Surgical stabilization techniques through anterior, posterior, and combined anteroposterior approaches have been reported for treating unstable hangman's fractures [1,[24][25][26][27][28][29]. Surgical options for unstable hangman's fractures through anterior approaches rely on a C2-C3 ACDF while posterior approaches mainly rely on a C2-C3 posterior cervical decompression and fusion (PCDF) with C2 pedicle and C3 lateral mass screws [1].…”

Section: Discussionmentioning

confidence: 99%

C2–C3 Anterior Cervical Discectomy and Fusion (ACDF) for Hangman's Fractures with C2 Posterior Dislocation: A Modified Classification of Hangman's Fractures and Technical Notes

Yufei¹,

GuanNan

et al. 2021

Preprint

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Background: The overwhelming majority of hangman’s fractures cause anterior dislocation of C2. Hangman’s fracture with C2 posterior dislocation is extremely rare, only one paediatric case was reported in 2018 to date. This kind of injury cannot be catalogued using current classification schemes and no established treatment recommendations exist. The purpose of this article is to report a rare case of a hangman's fracture with C2 posterior dislocation, which does not fit into existing classification systems, propose a new subtype of hangman’s fractures, and discuss management technical notes for the new subtype to avoid pitfalls. Methods: Description of case, review of relevant literatures and share our experience.Results: A 31-year-old male sustained hangman’s fracture with C2 posterior dislocation after fell into a 50cm deep roadside ditch when riding a motorcycle. Radiograph and computed tomography (CT) on admission showed fractures through both pars of C2 and C2 posterior dislocation. Magnetic resonance imaging (MRI) on admission showed high T2-weighted signal intensity of cervical spinal cord and compression of cervical spinal cord by posterior dislocation of C2 vertebral body. After 5 days of skull traction with 5 kg weight before operation, the dislocation aggravated. A C2-3 anterior cervical discectomy and fusion (ACDF) was performed. At 6 months after operation, bony fusion was achieved, and MRI showed the T2-weighted signal hyperintensity of cervical spinal cord before surgery disappeared.Conclusion: We proposed a new subtype of hangman's fractures here, type IIb hangman’s fractures: type II hangman’s fracture with C2 posterior dislocation. C2–C3 ACDF is recommended for type IIb hangman’s fractures. Traction before surgery is not recommended.

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Unstable Hangman's fracture: Anterior or posterior surgery?

Cited by 14 publications

References 28 publications

Surgical Management of the Hangman's Fracture in the Twelve Cases: Case Series

Surgical Management of the Hangman's Fracture in the Twelve Cases: Case Series

Fijación con tornillo transpedicular en C2 en el tratamiento de fractura de Hangman tipo III de Levine-Edwards: una opción para preservar el movimiento

C2–C3 Anterior Cervical Discectomy and Fusion (ACDF) for Hangman's Fractures with C2 Posterior Dislocation: A Modified Classification of Hangman's Fractures and Technical Notes

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