C2 Fractures : The Hangman’s Fracture

“Hangman’s fracture” is the colloquial name for a traumatic spinal cord injury that affects the axis vertebrae. Doctors have used this term since 1965, when some doctors used it to describe traumatic spondylolisthesis involving the pars interarticularis of C2 on both sides. Hangman’s fractures can involve the lamina, pedicles, pars, or articular facets of the axis vertebra. These fractures result from distraction and hyperextension of the spinal cord, as in car accidents when the chin strikes the dashboard, or—as the name implies—from certain hangings.

Mechanics of a Hangman’s Fracture

Patients with minor C2 fractures may discover their injuries after experiencing neck pain from a high-velocity hyperextension injury. In other cases, accident victims may be unconscious or suffer paralysis. When a major impact forces the head and neck to hyperextend, the cervical bones can fracture or severely dislocate—technically resulting in a broken neck. The C2 spine is the axis on which the vertebras pivot, enabling movement of the skull from side to side. C2 injuries are some of the most feared spinal cord injuries because in any spinal cord injury resulting in paralysis, the victim suffers paralysis in the rest of the body below the point of damage. Therefore, if a C2 fracture results in paralysis, the victim will lose movement and sensation below the neck—an injury that’s most often fatal or results in total paralysis.

Symptoms of a Hangman’s fracture will depend on the severity of the break or crack. In the most severe cases, the victim may suffer complete paralysis of the arms and legs, muscle atrophy, incontinence, the inability to speak, and/or trouble breathing without help. Survival from a Hangman’s fracture is relatively common, and many people with C2 fractures walk into the doctor simply complaining of neck pain after an accident. In these more minor cases, C2 fractures may not impair the victim at all, and victims will only need a brace to heal.

Symptoms of a minor C2 fracture can include problems moving the neck, pain, swelling, tenderness, trouble swallowing, loss of feeling or a tingling sensation in the arms and legs,numbness or pain at the base of the head, double vision, or loss of consciousness. A doctor will diagnose a Hangman’s fracture by doing a C-spine x-ray, CT scan, and/or MRI to assess the damage to your spinal cord.

Common Causes of C2 Fractures

Hangman’s fractures may occur in a car accident, after being thrown from a motorcycle or bike, falling, diving into a shallow pool, or during contact sports. Those between the ages of 65 and 84 are at the highest risk of C2 fractures due to falls. The most common cause of Hangman’s fractures are car accidents in which an unrestrained driver or passenger strikes the steering wheel or dashboard with the face or chin, causing the neck to hyperextend backward. Contact sports such as football can cause C2 fractures from high-velocity falls and dives to the ground for the ball. Falls from sports such as skateboarding can also cause C2 fractures.

Treatments for Hangman’s Fractures

Immediate treatment is necessary for a C2 fracture, as waiting and moving the injury can worsen the damage. As soon as an accident occurs, a victim should see a doctor for a potential C2 fracture. A doctor will stabilize the head and neck to prevent further damage, using a neck brace. If the fracture is minor, treatment will likely include immobilization and pain medication until the fracture heals. Severe C2 fractures may require surgery and physical therapy.

If a C2 fracture does not result in paralysis, the victim may experience pain or problems moving the head until the fracture completely heals. The prognosis for a C2 fracture is typically good if the fracture didn’t cause paralysis.

Sources:

http://radiopaedia.org/articles/hangman-fracture

http://www.bjj.boneandjoint.org.uk/content/jbjsbr/57-B/1/82.full.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489291/

https://www.med-ed.virginia.edu/courses/rad/cspine/fracture9.html

http://www.ncbi.nlm.nih.gov/pubmed/14288425

http://www.ncbi.nlm.nih.gov/pubmed/22157549

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