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Hangman fracture

A hangman fracture is a fracture which involves both pars interarticularis of C2, and is as a result of hyperextension and distraction. 

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 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 anterolithesis of C2 on C3

Treatment and prognosis

Treatment can be bracing or more typically internal fixation.

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 an historical note there are 4 methods of judicial  hanging and the process is more complicated than may be evident at first glance6

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