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Hyperextension cervical spine injury - Hangman and extension teardrop fractures

Case contributed by Dalia Ibrahim
Diagnosis certain

Presentation

Recent motor car accident. Presented with neck pain.

Patient Data

Age: 50 years
Gender: Male

Hangman fracture (bilateral pars fracture of C2 vertebra). C2 vertebra shows mild retrolithesis and small extension teardrop fracture at its anteroinferior aspect.

Rotatory subluxation injury of C2

First image shows: Hangman fracture (Bilateral pars break of C2 vertebra). (Yellow arrows)

Second image shows: C2 vertebra shows mild retrolithesis and small extension teardrop fracture at its anteroinferior aspect.(Red circle)

Third image shows: Rotatory subluxation injury of C2 (Yellow arrow)

Case Discussion

The case illustrates different forms of hyperextension cervical injuries.

Hyperextension cervical injuries are not uncommon and extremely serious.

Hangman fracture, also known as traumatic spondylolisthesis of the axis, is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.

Extension teardrop fracture typically occurs due to forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body. Extension teardrop fractures are stable in flexion and unstable in extension as the anterior longitudinal ligament is disrupted. Extension teardrop is not considered as severe as flexion teardrop fractures.

Atlanto-axial rotatory subluxation

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