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Hangman fracture

Dr Frank Gaillard et al.

Hangman fracture (also known as traumatic spondylolisthesis of axis) is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.

Clinical presentation

Post-traumatic neck pain after hyperextension high velocity injury is the most common presentation. Neurological impairment is seen only in 25% of patients.


This is known as a judicial lesion as these are the forces delivered by a noose, which, contrary to most ill-informed depictions, was placed with the knot towards the side of the neck, next to the angle of the mandible/mastoid process

This fracture is virtually never seen in suicidial hanging. Indeed it was not even seen in many of those who were judicially hanged; asphyxiation being the usual mode of death. Major trauma in hyperextension, such as a high speed motor vehicle accident, is in fact the most common association – especially in fatal cases.


See: Levine and Edwards classification

Radiographic features

  • bilateral lamina and pedicle fracture at C2
  • usually associated with anterolisthesis of C2 on C3

Extension of the fracture to the transverse foramina should be sought, raising the possibility of vertebral artery injury.

Treatment and prognosis

Treatment can be bracing or, more typically, internal fixation.

History and etymology

The term "hangman fracture" was introduced by Schneider in 1965 5. Strictly speaking, the fracture is actually misnamed and should more correctly be called "hangee" fracture. As a historical note there are four methods of judicial hanging and the process is more complicated than may be evident at first glance.

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