Hangman’s Fracture, C2 Fracture – Everything You Need To Know – Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes Hangman’s fractures.
Hangman’s Fracture is a bilateral fracture of the pars interarticularis. The spinal canal is widened and there is a low risk for spinal cord injury. The fracture usually occurs more due to motor vehicle accidents.
Anatomy
•Spinous process
•Body
•Axis
•Pars interarticularis
Mechanism of injury
Hyperextension will fracture the pars interarticularis with secondary flexion injury the disc and posterior ligament. The patient may have other associated spine fractures (up to 30%).
Levine and Edwards classification
Type I
•Stable fracture with less than 3 mm displacement
•No angulation
•Treatment: cervical orthosis
Type II
•Most common type
•Significant translation and some angulation
•Unstable fracture
•Treatment: cervical traction to improve the displacement and immobilization in halo vest.
Typer IIa
•Slight translation but severe angulation seen in flexion-distraction injuries with tearing of the posterior longitudinal ligament and the disc. The fracture is unstable.
•Treatment: reduction in extension and compression in a Halo. Do not use traction when there is severe angulation of the fracture.
Type III C2-C3 facet dislocation
•Rare fracture that results from initial anterior facet dislocation of C2 on C3 followed by extension injury fracturing the neural arch. Results in translation with unilateral or bilateral facet dislocation of C2-C3 unstable fracture.
•Treatment : Surgery for reduction of the facet dislocation and stabilization of the injury
Typical and atypical fractures
•A typical hangman’s fracture displaces the vertebral body anteriorly and its posterior element posteriorly. This creates increased space for the spinal cord.
•An atypical hangman’s fracture line leaves the canal circumferentially intact, which puts the spinal cord at risk of injury if displacement occurs.

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