Management of Typical and Atypical Hangman's Fractures. Al-Mahfoudh R, Beagrie C, Woolley E et al. A Novel Classification for Atypical Hangman Fractures and Its Application: A Retrospective Observational Study. Multidetector CT of Blunt Cervical Spine Trauma in Adults. The Management of Traumatic Spondylolisthesis of the Axis. A Classification Based on the Analysis of 131 Cases. Effendi B, Roy D, Cornish B, Dussault R, Laurin C. Management of Hangman's Fractures: A Systematic Review.

Hangman's Fracture: A Historical and Biomechanical Perspective. Rayes M, Mittal M, Rengachary S, Mittal S. Hangman's Fracture or Primary Spondylolysis: A Patient and a Brief Review. Hangman's Fracture: Radiologic Assessment in 27 Cases. Practical pointsĬheck for an extension to the transverse foramina and, if present, vertebral artery injury should be considered As a historical note, there are four methods of judicial hanging, and the process is more complicated than may be evident at first glance. Strictly speaking, the fracture is misnamed and should more correctly be called 'hangee' fracture. The term 'hangman fracture' was introduced by Schneider in 1965 5. Treatment can be a collar, halo, or surgical fixation.Ītypical hangman fractures may have a higher frequency of neurologic compromise than typical hangman fractures 11,12. Possible alignment abnormality: anterolisthesis of C2 on C3 or angulationĮxtension of the fracture to the transverse foramina should be sought, raising the possibility of vertebral artery injury. Typical: bilateral C2 pars interarticularis fracturesĪtypical variant: one or both sides of C2 has a coronal plane (vertically oriented) fracture through the posterior vertebral body instead of the pars interarticularis Radiography and CT demonstrate the findings: Some subclassifications of atypical hangman fractures have been proposed 11,12. Hangman fractures are described as 'typical' if only involving the pars interarticularis and as 'atypical' if one or both sides courses through the posterior body of the axis 10. Hangman fractures are commonly categorized by the degree of angulation or translation according to the Levine and Edwards classification 8, which is a modification of the original system described by Effendi 7.Ĭ2 fractures can also be classified under the AO Spine classification of upper cervical injuries as bony injury only (type A), tension band/ligamentous injury resulting in angular instability (type B), or translation (type C). Major trauma in hyperextension, such as a high-speed motor vehicle accident, is, in fact, the most common association – especially in fatal cases. This fracture is virtually never seen in suicidal hanging. However, it was not seen in many of those who were judicially hanged, with asphyxiation being the usual mode of death. This is known as a 'judicial lesion' as injury results from forces delivered by a noose, which was placed with the knot towards the side of the neck, next to the angle of the mandible/ mastoid process. Neurological impairment is seen only in 25% of patients. Post-traumatic neck pain after a high-velocity hyperextension injury is the most common presentation. These injuries account for 4-7% of all cervical spine fractures and up to 22% of axis fractures 6.

Cervical spine torn ligament x ray