Open AccessNeglected hangman fracture
Author(s) -
Sudhir Srivastava,
R. K. Aggarwal,
Pradip Sharad Nemade,
Sunil Krishna Bhoale
Publication year - 2015
Publication title -
journal of craniovertebral junction and spine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.38
H-Index - 23
eISSN - 0976-9285
pISSN - 0974-8237
DOI - 10.4103/0974-8237.167884
Subject(s) - medicine , pars interarticularis , surgery , kyphosis , spondylolisthesis , bony fusion , radiography , neck pain , supine position , bone grafting , myelopathy , arthrodesis , spinal cord , spondylolysis , lumbar , alternative medicine , pathology , psychiatry
Acute management of hangman fracture is well described; however the surgical management of neglected hangman fracture has not been described in literature. We report the surgical management of an untreated hangman's fracture. A 30-year-old male had fallen from a tree 12 weeks back. Patient presented with cervical myelopathy and restricted neck movements. Radiographs and computed tomography (CT) scan revealed fracture of pars interarticularis of axis with Grade III C2-C3 spondylolisthesis with localized kyphosis of 33°. Gentle reduction under general anesthesia (GA) failed to improve the alignment. Patient was operated in three stages in a single setting. In Stage I, release of contracted anterior structures and C2-C3 discectomy was done in supine position followed by C2-C3 posterior fixation and fusion in Stage II. C2-C3 interbody bone grafting and anterior plating completed the third stage. C2-C3 interbody fusion was seen at 5 months and a CT scan at 18 months postoperative confirmed fusion and maintenance of alignment. The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.