Fractures and Dislocations: C2 (Hangman's Fracture)

C2 (Hangman’s Fracture) :  Unstable but uncommon.

• Traumatic Spondylolisthesis of the Axis with or without anterior subluxation of  C2 on C3

• Occurs with rapid deceleration (hanging) and with hyperextension (MVA – chin to dashboard)

• Bilateral C2 pars (common) or Pedicle (less common)

 Most patients do not survive. The X-ray findings may be very subtle or very obvious:

    
On the left is an obvious fracture/dislocation of C2. The C2 fracture on the right is less obvious, but shows a disruption of the "life lines."

    
The film on the left shows anterior Soft tissue swelling.  The right film is a magnification. There is a fracture of the pedicle (neural arch ) of  C2 . The inferior articular facets of C2 are displaced inferiorly. Minimal disruption of the Cervical lines indicating minimal subluxation.

This CT scan of C2 clearly shows the fracture

This section written by:

LCDR Ron Boucher, MC, USN
LT Hugh McSwain, MC, USN

With some assistance from:

CDR Michael Puckett, MC, USN
ENS Robert Post, MC, USNR