Hangman's fracture: Difference between revisions
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==Background== | ==Background== | ||
*Also known as traumatic spondylolisthesis | *Also known as traumatic spondylolisthesis | ||
*Is an [[unstable spine fractures|unstable spine injury]] | *Is an [[unstable spine fractures|<u>unstable</u> spine injury]] | ||
*Bilateral C2 pedicle fracture (leads to C2 displacing anteriorly on C3) | *Bilateral C2 pedicle fracture (leads to C2 displacing anteriorly on C3) | ||
{{Vertebral fractures and dislocations types}} | |||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Blunt neck trauma DDX}} | ||
== | ==Evaluation== | ||
*Xray or CT cervical spine | |||
==Management== | ==Management== | ||
===Prehospital Immobilization=== | ===Prehospital Immobilization=== | ||
See [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]] | *See [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]] | ||
===Hospital=== | ===Hospital=== | ||
*C-collar | |||
*Consult ortho or neurosurgery | |||
**External fixation via rigid cervical orthosis or halo-vest orthosis 8-14 weeks (~90% healing with immobilization alone) <ref>Coric D, Wilson JA, Kelly DL Jr. Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases. J Neurosurg. 1996 Oct;85(4):550-4. doi: 10.3171/jns.1996.85.4.0550. Erratum in: J Neurosurg. 1996 Dec;85(6):1198. PMID: 8814154.</ref> | |||
**Surgical fixation, especially if there is:<ref>Murphy H, Schroeder GD, Shi WJ, Kepler CK, Kurd MF, Fleischman AN, Kandziora F, Chapman JR, Benneker LM, Vaccaro AR. Management of Hangman's Fractures: A Systematic Review. J Orthop Trauma. 2017 Sep;31 Suppl 4:S90-S95. doi: 10.1097/BOT.0000000000000952. PMID: 28816880.</ref> | |||
***Severe angulation of C2 on C3 | |||
***Disruption of C2 to C3 disc space | |||
***Inability to establish or maintain alignment with external immobilization | |||
***Nonunion after use of external immobilization | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Cervical spine injuries]] | *[[Cervical spine injuries]] | ||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 20:04, 12 January 2021
Background
- Also known as traumatic spondylolisthesis
- Is an unstable spine injury
- Bilateral C2 pedicle fracture (leads to C2 displacing anteriorly on C3)
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Clinical Features
- Seen in MVA, diving accidents, but uncommonly judicial hangings (not in suicidal hangings)[1]
- Forced extension of an already extended neck
- Spinal cord damage is often minimal (diameter of neural canal is greatest at C2)
Differential Diagnosis
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Evaluation
- Xray or CT cervical spine
Management
Prehospital Immobilization
Hospital
- C-collar
- Consult ortho or neurosurgery
- External fixation via rigid cervical orthosis or halo-vest orthosis 8-14 weeks (~90% healing with immobilization alone) [2]
- Surgical fixation, especially if there is:[3]
- Severe angulation of C2 on C3
- Disruption of C2 to C3 disc space
- Inability to establish or maintain alignment with external immobilization
- Nonunion after use of external immobilization
Disposition
- Admit
See Also
External Links
References
- ↑ James, R. and Nasmyth-Jones, R. (1992) ‘The occurrence of cervical fractures in victims of judicial hanging’, Forensic Science International, 54(1), pp. 81–91
- ↑ Coric D, Wilson JA, Kelly DL Jr. Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases. J Neurosurg. 1996 Oct;85(4):550-4. doi: 10.3171/jns.1996.85.4.0550. Erratum in: J Neurosurg. 1996 Dec;85(6):1198. PMID: 8814154.
- ↑ Murphy H, Schroeder GD, Shi WJ, Kepler CK, Kurd MF, Fleischman AN, Kandziora F, Chapman JR, Benneker LM, Vaccaro AR. Management of Hangman's Fractures: A Systematic Review. J Orthop Trauma. 2017 Sep;31 Suppl 4:S90-S95. doi: 10.1097/BOT.0000000000000952. PMID: 28816880.