Hangman's fracture

Case contributed by Dr Ian Bickle

Presentation

Road traffic accident whilst under the influence of alcohol. Neurologically stable.

Patient Data

Age: 20 years
Gender: Female

Cervical spine

CT

Bilateral pars interarticularis fractures of C2 vertebra. The right parsinterarticularis fracture is slightly displaced.

C2-C3 disc height is mildly increased with subtle anterolisthesis of C2.

No significant paraspinal hematoma or spinal cord compression.

The atlantodental and atlantoaxial spaces are normal.

Cervical spine

MRI

Bilateral pars interarticularis fractures.

Focal disruption of anterior longitudinal ligament at C2/3 level.

The posterior longitudinal ligament is intact. No significant anterolisthesis.

Bone marrow edema involving the superior endplates of C3 and T2 vertebral bodies.

The spinal cord is of normal caliber and signal. No evidence of cord edema or contusion.

Case Discussion

Hangman fracture  is a fracture which involves both pars interarticularis of the C2 vertebra.  It is typically the result of a hyperextension and distraction injury.

The name originates from the injury sustained during judicial hanging.  In this case a high speed RTA was the responsible mechanism responsible for the hyperextension injury of this patient's cervical spine.

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