title: Hangman's fracture: the relationship between asymmetry and instability.
abstract: There is ambiguity concerning the nomenclature and classification of fractures of the ring of the second cervical vertebra (C2). Disruption of the pars interarticularis which defines true traumatic spondylolisthesis of C2, is often wrongly called a pedicle fracture. Our aim in this study was to assess the influence of asymmetry on the anatomical and functional outcome and to evaluate the criteria of instability established by Roy-Camille et al. We studied the plain radiographs and CT scans of 24 patients: 13 were judged to be asymmetrical, ten were considered unstable and 14 stable. Treatment was with a Minerva jacket in 15 fractures and by operation in nine. Surgery was undertaken in patients with severe C2 to C3 sprains. One patient with an unstable lesion refused operation and was treated conservatively with a poor radiological result. Our study showed that asymmetry of the fracture did not affect the outcomes of treatment and should not therefore influence decisions in treatment. The criteria of Roy-Camille seem to be reliable and useful. We prefer the posterior approach to the cervical spine, which allows both stabilisation of the fracture and correction of a local kyphosis.
authors.affiliation: Pierre et Marie Curie University, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Samaha
authors.forename: J Y
authors.initials: JY
authors.lastname: Lazennec
authors.forename: C
authors.initials: C
authors.lastname: Laporte
authors.forename: G
authors.initials: G
authors.lastname: Saillant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007403:Intervertebral Disc / Q000293:injuries; D004204:Joint Dislocations / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D017846:Longitudinal Ligaments / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D016103:Spinal Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000293:injuries