C2 Hangman’s

Background 

  • Bilateral pars fracture 

Classification 

  • Type 1 
    • Axial and hyperextension 
    • <3mm displacement stable 
    • Management 
      • Collar 
  • Type 1A  
    • pars on one side body on the other (more unstable) 
    • Management 
      • Halo 
  • Type 2 
    • Type 1 then rebound flexion 
    • >3mm 
    • Management 
      • Halo 
      • C23 ACDF 
      • C1-3 PSIF 
  • Type 2A 
    • Flexion distraction 
    • Angulated 
    • Management 
      • Reduction with Halo 
      • C23 ACDF 
      • C1-2 PSIF 
  • Type 3 
    • Hangman plus facet dislocation 
    • MRI r/o disc 
    • Management 
      • C1-3 PSIF 
      • C23 ACDF +/- C1-3 PSIF 

C Spine Instability 

  • White’s Rule 
  • 3.5mm translationn 
  • 10degrees kyphosis 

Hangman fracture, what is true? (repeat) 

Usually flexion mechanism) 

usually do well (high rate of union) with non op treatment 

Associated with neurocompromise  

related to C3-4 ligament sprain