Hangman's Fracture / Cervical Spine

Figure 25. Sagittal T1-weighted MR image of the cervical spine shows a hangman fracture with ligamentous injury and extensive prevertebral and epidural hematoma







Figure 13. Sagittal T2-weighted MR image of the cervical spine in a pediatric patient shows a C2 fracture with disruption of the tectorial membrane (arrow), findings that indicate a severe and unstable injury.




A Hangman's fracture is a fracture of both pedicles or pars interarticularis of the axis vertebra, the second cervical vertebra(C2). The fracture can be with or without subluxation of C2 or C3 and often causes death.

The name Hangman's fracture came from a broken neck involving a fracture of an upper cervical vertebra similar to the injury suffered in death by hanging. The head would be forced into hyperextension by the full weight of the body and therefore the force and distraction of the neck would cause the fracture. Now days this injury is seen due to sports injuries, motor vehicle accidents, diving into shallow water, along with deliberate or suicidal hanging.

Severe pain will usually be present at the point of injury. Pressure on a nerve may also cause pain from the neck down into the shoulders and arms. Bruising and swelling may be present at the back of the neck. When these symptoms arise, Doctors will usually order X-rays to detemine the severity and location of any fracture. Also they may order a neurological exam to be performed to assess for spinal cord injury. CT scans may also be ordered to look for abnormallties not visible by regular X-rays. Also MRI tests can be ordered to provide high resolution images of soft tissue to further determine damage to the spinal cord. Worse senario a patient may experience immediate consequences of numbness and paralysis in much of the body which makes this a very serious and unstable injury.

When numbness and paralysis are the symptoms, complete immoblizaton of the head and neck should be done as early as possible and before moving the patient. Immobilization is imperative to minimise or prevent further spinal cord injury. Collars, and traction should be used to immoblize and stablilize the neck before diagnosis and when cervical fracture has been diagnosed.

Surgery may be needed to stabilize the neck to relieve pressure on the spinal cord. Different surgeries are available depending on the injury. Vertabrae may have to be fused together to provide stability. Metal plates, screws, or wires may be needed to hold vertabrae or pieces of the vertabrae in place.