Hangman's fracture

Case contributed by Frank Gaillard


Involved in a motor vehicle accident.

Patient Data

Age: 40 years
Gender: Female

Trauma Radiology Course Over 6 hours of video. Available here

Cervical spine


Bilateral fracture through the pedicles of C2 is demonstrated, alignment is similar to previous cross-sectional imaging with approximately 10° of forward tilt and 3 mm of anterior subluxation.

Cervical spine


There is a fracture through bilateral pedicles of C2 with the fracture line extending through the right foramen transversarium and right intertubercular lamina. On the left, the fracture line involves the posterior tubercle of the left transverse process. The medial aspect of the fractured right pedicle is displaced medially into the spinal canal contacting but not significantly effacing the thecal sac. This fracture is associated with subtle widening of the C2/3 facet joints greater on the left, suspicious for bilateral facet joint subluxation. There is an associated hematoma that measures up to 3 mm in maximum depth that elevates the posterior longitudinal ligament and tectorial membrane.

Opacity at the C3/4 intervertebral disc level with resulting mild compression of the cervical cord may be due to hematoma or disc protrusion.

No other cervical spine fracture is identified. There is no significant prevertebral hematoma.


Marked edema and widening within the C1/2 interspinous space suggesting ligamentous disruption. Edema is seen in the lateral masses of C2 compatible with fracture. Fluid is seen in the lateral C 1/2 articulations.

Lifting of the posterior longitudinal ligament posterior to C2 suggests extruded disc material.

Focal central disc bulge at C3/4 with likely disc extrusion with lifting of the posterior longitudinal ligament which appears thickened. There may be a small component of epidural blood products at this level.

Mild edema without widening is seen at the C2/3 and C3/4 interspinous spaces.

Normal flow voids within the vertebral arteries.

Mild edema superior to the dens may indicate supradental ligamentous sprain.

Hematoma seen within the paravertebral muscles at C2-C4.

The cervical cord has normal signal throughout.


  • Likely disruption of the interspinous ligaments at C1/2.
  • Interspinous ligamentous sprain C2/3 and C3/4
  • Disc extrusions at C2/3 and C3/4 with a small component of epidural hematoma at the latter level
  • Mild supradental edema may indicate ligamentous sprain.

Case Discussion

Typical features of a hangman's fracture with associated ligamentous injuries. 

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