![]() ![]() ![]() Typical: bilateral C2 pars interarticularis fracturesĪtypical variant: one or both sides of C2 has a coronal plane (vertically oriented) fracture through the posterior vertebral body instead of the pars interarticularis Radiography and CT demonstrate the findings: Some subclassifications of atypical hangman fractures have been proposed 11,12. Hangman fractures are described as "typical" if only involving the pars interarticularis and as "atypical" if one or both sides courses through the posterior body of the axis 10. Hangman fractures are commonly categorized by the degree of angulation or translation according to the Levine and Edwards classification 8, which is a modification of the original system described by Effendi 7.Ĭ2 fractures can also be classified under the AO Spine classification of upper cervical injuries as bony injury only (type A), tension band/ligamentous injury resulting in angular instability (type B), or translation (type C). Major trauma in hyperextension, such as a high-speed motor vehicle accident, is, in fact, the most common association – especially in fatal cases. This fracture is virtually never seen in suicidal hanging. However, it was not seen in many of those who were judicially hanged, with asphyxiation being the usual mode of death. This is known as a 'judicial lesion' as injury results from forces delivered by a noose, which was placed with the knot towards the side of the neck, next to the angle of the mandible/ mastoid process. Neurological impairment is seen only in 25% of patients. Post-traumatic neck pain after a high-velocity hyperextension injury is the most common presentation. These injuries account for 4-7% of all cervical spine fractures and up to 22% of axis fractures 6. ![]()
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