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Spine
Diagnosis
Trauma
Vertebral Column, Discs, and Paraspinal Muscle
Hangman's C2 Fracture
Hangman's C2 Fracture
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Traumatic spondylolisthesis of axis (TSA)

          • Definitions

            • Fractures through bilateral C2 pars interarticularis
            • Avulsion of C2 body from facets, neural arch

          IMAGING

          • General Features

            • Radiographic Findings

              • Fluoroscopic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Patel JYK et al: Unstable hangman's fracture: anterior or posterior surgery? J Craniovertebr Junction Spine. 10(4):210-5, 2019
                                        2. Al-Mahfoudh R et al: Management of typical and atypical hangman's fractures. Global Spine J. 6(3):248-56, 2016
                                        3. Hadley MN et al: Introduction to the guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 72 Suppl 2:5-16, 2013
                                        4. Ryken TC et al: Management of isolated fractures of the axis in adults. Neurosurgery. 72 Suppl 2:132-50, 2013
                                        5. Pryputniewicz DM et al: Axis fractures. Neurosurgery. 66(3 Suppl):68-82, 2010
                                        6. Yanni DS et al: Fixation of the axis. Neurosurgery. 66(3 Suppl):147-52, 2010
                                        7. Congress of Neurological Surgeons: Isolated fractures of the axis in adults. Neurosurgery. 50(3 Suppl):S125-39, 2002
                                        8. Congress of Neurological Surgeons: Management of combination fractures of the atlas and axis in adults. Neurosurgery. 50(3 Suppl):S140-7, 2002
                                        9. Ranjith RK et al: Hangman's fracture caused by suspected child abuse. A case report. J Pediatr Orthop B. 11(4):329-32, 2002
                                        10. Harrop JS et al: Acute respiratory compromise associated with flexed cervical traction after C2 fractures. Spine. 26(4):E50-4, 2001
                                        11. Samaha C et al: Hangman's fracture: the relationship between asymmetry and instability. J Bone Joint Surg Br. 82(7):1046-52, 2000
                                        12. Agrillo U et al: Hangman's fracture. Spine. 24(22):2412, 1999
                                        13. Guiot B et al: Complex atlantoaxial fractures. J Neurosurg. 91(2 Suppl):139-43, 1999
                                        14. Josten C: [Traumatic spondylolisthesis of the axis.] Orthopade. 28(5):394-400, 1999
                                        15. Williams JP 3rd et al: CT appearance of congenital defect resembling the Hangman's fracture. Pediatr Radiol. 29(7):549-50, 1999
                                        16. Greene KA et al: Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine. 22(16):1843-52, 1997
                                        17. Nunez DB Jr et al: Cervical spine trauma: how much more do we learn by routinely using helical CT? Radiographics. 16(6):1307-18; discussion 1318-21, 1996
                                        18. Starr JK et al: Atypical hangman's fractures. Spine. 18(14):1954-7, 1993
                                        19. James R et al: The occurrence of cervical fractures in victims of judicial hanging. Forensic Sci Int. 54(1):81-91, 1992
                                        20. Parisi M et al: Hangman's fracture or primary spondylolysis: a patient and a brief review. Pediatr Radiol. 21(5):367-8, 1991
                                        21. Burke JT et al: Acute injuries of the axis vertebra. Skeletal Radiol. 18(5):335-46, 1989
                                        22. Fielding JW et al: Traumatic spondylolisthesis of the axis. Clin Orthop. (239):47-52, 1989
                                        23. Mirvis SE et al: Hangman's fracture: radiologic assessment in 27 cases. Radiology. 163(3):713-7, 1987
                                        24. Baumgarten M et al: Computed axial tomography in C1-C2 trauma. Spine. 10(3):187-92, 1985
                                        25. Hadley MN et al: Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery. 17(2):281-90, 1985
                                        26. Levine AM et al: The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am. 67(2):217-26, 1985
                                        27. Sherk HH et al: Clinical and pathologic correlations in traumatic spondylolisthesis of the axis. Clin Orthop. (174):122-6, 1983
                                        28. Bucholz RW: Unstable hangman's fractures. Clin Orthop. (154):119-24, 1981
                                        29. Pepin JW et al: Traumatic spondylolisthesis of the axis: hangman's fracture. Clin Orthop. (157):133-8, 1981
                                        30. Seljeskog EL et al: Spectrum of the hangman's fracture. J Neurosurg. 45(1):3-8, 1976
                                        31. Marar BC: Fracture of the axis arch. "Hangman's fracture" of the cervical spine. Clin Orthop. (106):155-65, 1975
                                        32. Williams TG: Hangman's fracture. J Bone Joint Surg Br. 57(1):82-8, 1975
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Traumatic spondylolisthesis of axis (TSA)

                                                • Definitions

                                                  • Fractures through bilateral C2 pars interarticularis
                                                  • Avulsion of C2 body from facets, neural arch

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • Fluoroscopic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Patel JYK et al: Unstable hangman's fracture: anterior or posterior surgery? J Craniovertebr Junction Spine. 10(4):210-5, 2019
                                                                              2. Al-Mahfoudh R et al: Management of typical and atypical hangman's fractures. Global Spine J. 6(3):248-56, 2016
                                                                              3. Hadley MN et al: Introduction to the guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 72 Suppl 2:5-16, 2013
                                                                              4. Ryken TC et al: Management of isolated fractures of the axis in adults. Neurosurgery. 72 Suppl 2:132-50, 2013
                                                                              5. Pryputniewicz DM et al: Axis fractures. Neurosurgery. 66(3 Suppl):68-82, 2010
                                                                              6. Yanni DS et al: Fixation of the axis. Neurosurgery. 66(3 Suppl):147-52, 2010
                                                                              7. Congress of Neurological Surgeons: Isolated fractures of the axis in adults. Neurosurgery. 50(3 Suppl):S125-39, 2002
                                                                              8. Congress of Neurological Surgeons: Management of combination fractures of the atlas and axis in adults. Neurosurgery. 50(3 Suppl):S140-7, 2002
                                                                              9. Ranjith RK et al: Hangman's fracture caused by suspected child abuse. A case report. J Pediatr Orthop B. 11(4):329-32, 2002
                                                                              10. Harrop JS et al: Acute respiratory compromise associated with flexed cervical traction after C2 fractures. Spine. 26(4):E50-4, 2001
                                                                              11. Samaha C et al: Hangman's fracture: the relationship between asymmetry and instability. J Bone Joint Surg Br. 82(7):1046-52, 2000
                                                                              12. Agrillo U et al: Hangman's fracture. Spine. 24(22):2412, 1999
                                                                              13. Guiot B et al: Complex atlantoaxial fractures. J Neurosurg. 91(2 Suppl):139-43, 1999
                                                                              14. Josten C: [Traumatic spondylolisthesis of the axis.] Orthopade. 28(5):394-400, 1999
                                                                              15. Williams JP 3rd et al: CT appearance of congenital defect resembling the Hangman's fracture. Pediatr Radiol. 29(7):549-50, 1999
                                                                              16. Greene KA et al: Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine. 22(16):1843-52, 1997
                                                                              17. Nunez DB Jr et al: Cervical spine trauma: how much more do we learn by routinely using helical CT? Radiographics. 16(6):1307-18; discussion 1318-21, 1996
                                                                              18. Starr JK et al: Atypical hangman's fractures. Spine. 18(14):1954-7, 1993
                                                                              19. James R et al: The occurrence of cervical fractures in victims of judicial hanging. Forensic Sci Int. 54(1):81-91, 1992
                                                                              20. Parisi M et al: Hangman's fracture or primary spondylolysis: a patient and a brief review. Pediatr Radiol. 21(5):367-8, 1991
                                                                              21. Burke JT et al: Acute injuries of the axis vertebra. Skeletal Radiol. 18(5):335-46, 1989
                                                                              22. Fielding JW et al: Traumatic spondylolisthesis of the axis. Clin Orthop. (239):47-52, 1989
                                                                              23. Mirvis SE et al: Hangman's fracture: radiologic assessment in 27 cases. Radiology. 163(3):713-7, 1987
                                                                              24. Baumgarten M et al: Computed axial tomography in C1-C2 trauma. Spine. 10(3):187-92, 1985
                                                                              25. Hadley MN et al: Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery. 17(2):281-90, 1985
                                                                              26. Levine AM et al: The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am. 67(2):217-26, 1985
                                                                              27. Sherk HH et al: Clinical and pathologic correlations in traumatic spondylolisthesis of the axis. Clin Orthop. (174):122-6, 1983
                                                                              28. Bucholz RW: Unstable hangman's fractures. Clin Orthop. (154):119-24, 1981
                                                                              29. Pepin JW et al: Traumatic spondylolisthesis of the axis: hangman's fracture. Clin Orthop. (157):133-8, 1981
                                                                              30. Seljeskog EL et al: Spectrum of the hangman's fracture. J Neurosurg. 45(1):3-8, 1976
                                                                              31. Marar BC: Fracture of the axis arch. "Hangman's fracture" of the cervical spine. Clin Orthop. (106):155-65, 1975
                                                                              32. Williams TG: Hangman's fracture. J Bone Joint Surg Br. 57(1):82-8, 1975