Revision Procedure After Surgery for Atypical Hangman’s Fracture Primarily Performed Only from the Posterior Approach – An Attempt to Maintain Head Rotation: Case Report

Abstract

Introduction

Hangman’s fracture, also known as traumatic spondylolisthesis of the axis, is defined as a bilateral fracture of the C2 pars interarticularis. In 1965, Schneider used this term to describe a pattern of similarities seen in fractures associated with judicial hangings. However, this fracture pattern is only observed in approximately 10% of injuries associated with hangings.

Case Report

We present a case of an atypical hangman’s fracture caused by a headlong dive into a swimming pool and striking the pool’s bottom. The patient had undergone surgery at another centre, where posterior C2-C3 stabilisation was performed. Due to the presence of screws in the C1-C2 joint spaces, the patient could not perform rotational movements of the head. Anterior stabilization to prevent C2 dislocation against C3 was also not performed, and appropriate spinal stability was not ensured. Our decision to reoperate was motivated, among other factors, by our intention to restore rotational head movements. The revision surgery was performed from both an anterior and posterior approach. After the surgery, the patient was able to rotate his head while maintaining cervical spine stability. The case presented here represents not only a unique example of an atypical C2 fracture but also highlights a fixation technique that provided the necessary stability for successful fusion. The utilized method restored functional rotational movement of the head, thus preserving the patient’s quality of life, which is of paramount importance considering the patient’s age.

Conclusion

The decision-making process regarding the technique for treating hangman’s fractures, especially atypical fractures, should account for the patients’ quality of life after the operation. The preservation of as much of the physiological range of motion as possible with maintained spinal stability should be the goal of therapy in every case.

Keywords:

• hangman’s fracture
• traumatic spondylolisthesis of C2
• axis fracture
• cervical spine
• fusion

Data Sharing Statement

Data, anonymized images/DICOM files supporting the results of this study, can be assessed on request to the corresponding author.

Consent for Publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Disclosure

The authors declare no conflict of interest.

Additional information

Funding

This research received no external funding.