Identify the condition shown by the X ray:
A. Jefferson Fracture
B. Hangman’s fracture
C. Cervical Burst Fracture
D. Cervical Facet Dislocation
Ans:B. Hangman’s fracture.
Image shows:X-ray of the cervical spine with a Hangman’s fracture. Left without, right with annotation. C2 (outlined in red) is moved forward with respect to C3 (outlined in blue).
- Hangman fracture, also known as traumatic spondylolisthesis of the axis, is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.
- Post-traumatic neck pain after a high-velocity hyperextension injury is the most common presentation. Neurological impairment is seen only in 25% of patients.
- This is known as a ‘judicial lesion’ as these are the forces delivered by a noose, which, contrary to most ill-informed depictions, was placed with the knot towards the side of the neck, next to the angle of the mandible/mastoid process.
- This fracture is virtually never seen in suicidal hanging.
- Indeed, it was not even seen in many of those who were judicially hanged; asphyxiation being the usual mode of death.
- Major trauma in hyperextension, such as a high-speed motor vehicle accident, is, in fact, the most common association – especially in fatal cases.
- Levine and Edwards classification
Radiographic features :
- bilateral lamina and pedicle fracture at C2
- usually associated with anterolisthesis of C2 on C3
- Treatment can be bracing or, more typically, internal fixation.