The hangman’s fracture refers to the bilateral fracture of
the pars interarticularis. When this fracture occurs, the spinal canal is
widened and there is a low risk for spinal cord injury. This fracture usually
occurs due to motor vehicle accidents.
Hyperextension will fracture the pars interarticularis with
secondary flexion, injuring the disc and posterior ligament. The patient may
have other associated spine fractures.
Hangman’s fractures are identified by types using the Levine and Edwards
Classification.
 |
| Type I |
Type I:
- Stable fracture with less than 3mm displacement
- No angulation
- Treatment: Cervical Orthosis
 |
| Type II |
Type II:
- Most common type
- Significant translation and some angulation
- Unstable fracture
- Treatment: Cervical traction to improve the displacement and immobilization in halo vest
 |
| Type IIa |
Type IIa:
- Slight translation but severe anglulation 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 |
Type III:
- C2-C3 facet dislocation
- Rare fracture that results from initial anterior facet dislocation of C2 on C3, followed by an 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.
 |
| Atypical Hangman's Fracture |
An atypical hangman’s fracture line leave the canal
circumferentially intact, which puts the spinal cord at risk of injury if
displacement occurs.
