Presentation
Hyperflexion injury to neck.
Patient Data
Bilateral pars interarticularis fractures of C2 vertebra. Right pars interarticularis fracture is relatively displaced. C2-C3 disc height is mildly increased with grade II anterolisthesis of C2 over C3.
No significant prespinal hematoma or spinal cord compression. The atlanto-dental spaces are normal. Rest of the cervical vertebrae are normal. The craniovertebral junction is intact.
Case Discussion
Traumatic spondylolisthesis of axis with fractures of the C2 pedicles was first described in a patient with motor vehicle accidents. Then the term hangman’s fracture was described for similar features of traumatic fractures of axis in judicial hanging.
The mechanism of this fracture is distraction and hyperextension, currently the common causes being motor vehicle accidents, diving, and falls.
Types:
- type 1: no angulation and no displacement (or minimal displacement <2-3 mm) of C2 with normal C2-3 intervertebral disc.
- type 2: anterior angulation or displacement of C2 vertebral body with disruption of C2-3 intervertebral disc.
- type 3: anterior displacement and hyperflexion of C2 vertebral body with unilateral or bilateral facet dislocation.
The current case is in favor of Hangman's fracture type 3.