Hangman's and extension tear drop fractures

Case contributed by Dr Kenny Sim


Football injury.

Patient Data

Age: 30-35
Gender: Male

CT Cervical spine

There is a hangman's fracture of C2 with the fracture lines extending into the transverse foramina bilaterally. This is associated with disruption of the normal atlantoaxial alignment with the atlas rotated to the right relative to the axis. There is also a moderately displaced teardrop fracture involving the anteroinferior aspect of the vertebral body of C2. No odontoid fracture. A well corticated osseous fragment adjacent to the inferior aspect of the anterior arch of the atlas has a chronic appearance. Unremarkable atlantooccipital alignment. No significant narrowing of the spinal canal within the upper cervical spine on CT.

No other cervical spine fracture identified. Small disc protrusion eccentric to the left at C 5/6 does not result in any significant canal narrowing.

Conclusion: Unstable hangman's fracture of C2 as well as a teardrop avulsion injury of the C2 vertebral body with C1/2 rotatory subluxation. The possibility of injury to the vertebral arteries is raised and further evaluation with a CTA is suggested.

Case Discussion

Both Hangman and C2 teardrop fractures are hyperextension injuries usually as a result of high energy trauma. The clinical details and mechanism in this case are slightly incongruent with the degree of injuries sustained.

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Case information

rID: 38490
Published: 23rd Jul 2015
Last edited: 14th Aug 2019
Tag: rmh
Inclusion in quiz mode: Included

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