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Hangman fracture

Hangman fracture is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.

Pathology

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 such as a high speed motor vehicle accident is in fact the most common association, especially in fatal cases.

Radiographic features

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

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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