Hangman’s Fractures: A Review of Current Concepts in Evaluation and Management

STUDY DESIGN: Review article. OBJECTIVE: To provide a comprehensive review and update on the evaluation and management of Hangman's fractures. SUMMARY OF BACKGROUND DATA: Hangman's fractures are the second most common fracture of the C2 vertebrae, and the prevalence is increasing with our aging population. Although these injuries are associated with good clinical outcomes and low rates of neurologic injury, they must be promptly recognized and treated according to patient and fracture factors. METHODS: A review of the literature. RESULTS: Neurologic injuries are uncommon in typical Hangman's fractures but are more of a concern in atypical Hangman's fractures due to lack of dissociation of the posterior ring of C2. The nonoperative treatment of stable type I, II, and atypical fractures with external immobilization leads to excellent long-term outcomes as does the operative treatment of unstable type IIa, III, and atypical fractures. CONCLUSIONS: Stable injury patterns can be treated with immobilization alone, whereas unstable injury patterns necessitate surgical treatment. Prompt diagnosis and treatment Hangman's fractures is paramount, and when managed properly, patients can have excellent clinical and neurologic outcomes.