Hangman's fracture: arguments in favor of surgical therapy for type II and III according to Edwards and Levine.

BACKGROUND

The optimal therapy for traumatic fractures of the neural arch of the axis, the so-called hangman's fractures, is still controversial. Indications for surgery depend on the type of hangman's fracture and/or additional injuries of the intervertebral disc or ligaments.

METHODS

Sixteen patients sustaining fractures of the neural arch of the axis were treated by the screw fixation technique evolved by Judet. The passive mobility of the cervical spine was analyzed postoperatively by the radiographic evaluation method of Dvorak and coworkers and Penning. The angulation and anterior translation of C2 on C3 was measured before and after surgery.

RESULTS

Follow-up investigations 3, 12, and in some cases 45 months later confirmed sufficient functional results especially regarding the mobility of the upper cervical spine. Comparison of pre- and postoperative angulation and anterior translation of C2 on C3 revealed a significant improvement especially in cases with type IIa fractures.

CONCLUSION

The stabilization technique of Judet facilitates an exact reconstruction of anatomical conditions thereby preserving the atlantoaxial rotational mobility. A negligible hypomobility of the C2-C3 segment was observed on average 18 months after surgery.