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There are mildly displaced fractures involving both the right and left posterior elements of C2, at the pars interarticularis, with extension into the posterior aspect of the foramen transversarium bilaterally. There is mild diastasis at the fracture site which extends to the articular surface of the lateral atlantoaxial joints bilaterally. No extension to the vertebral body or other fracture noted.
Given the transverse foramen involvement, a CT angiogram of the neck was recommended (not included) and showed a small mural injury of the transverse portion of the right vertebral artery at the level of the C2 fracture.
This case describes a typical appearance of Hangman fracture, with fractures of the posterior elements of C2, which is caused by hyperextension and distraction. The C2 vertebral body may displace anteriorly relative of C3. Almost all cases are now sequelae of accidents rather than hanging and can be stable or unstable. Only a minority of cases are associated with neurological sequelae as the fractured posterior elements essentially result in decompression of the spinal canal. When involvement of foramen transversarium is seen, it is important to recommend urgent CTA of the neck to rule out a vascular injury. Additional fracture levels are seen in approximately a third of cases, C1 most commonly.
Case co-author: Rehana Jaffer, MD, FRCPC
(Case courtesy of Dr. Mathieu Boily)
- 1. William E. Brant, Clyde A. Helms. Fundamentals of Diagnostic Radiology. (2020) ISBN: 9780781761352