title: Results of direct repair of type 2 hangman fracture using Iso-C3D navigation: 20 cases.
abstract: METHODS
  Prospective Study.
  
  
  OBJECTIVE
  To study the results of direct repair of type 2 hangman fracture using Iso-C3D navigation.
  
  
  BACKGROUND
  Direct fixation of axis pedicle fracture gives biomechanically stronger stability and early mobilization. These fixations are technically demanding. Very few cases of direct fixation using Iso-C3D navigation are reported. We report the largest series of directly fixed hangman fractures so far.
  
  
  METHODS
  Twenty type 2 hangman fractures (18 men and 2 women), in age group of 17-63 years (average, 38 y), were treated by posterior direct repair using Judet screws under Iso-C3D navigation. Twelve had road traffic accident, 7 had fallen from height, and 1 had direct injury to head. Nine had limb or pelvic fractures. Eighteen patients had normal, 2 had ASIA D, and 1 had ASIA B neurology.
  
  
  RESULTS
  With no intraoperative complications, 18 patients underwent bilateral pedicle fixation and 2 underwent unilateral fixation, with an average blood loss of 220 mL. Average follow-up was 29 months. Postoperative images showed good reduction with union in an average of 8 weeks. Average anterior translation of 3.2 mm preoperatively was reduced to 1.0 mm postoperatively. Computed tomography axial cuts distance with an average of 3.57 mm on right side and 3.66 mm on left side were reduced to 0.40 and 0.46 mm postoperatively. Two cases presenting with pseudoarthrosis showed consolidation after 25 weeks of surgery. Visual analog score of 7 preoperatively reduced to 1 by 8 weeks, 0 by 20 weeks postoperatively, except in 2 patients. In one patient, screws were removed after 8 months postoperatively and in other patient pain subsided gradually by 7 months. According to Myung-Sang Moon Assessment Criteria, 14 had excellent, 3 had good, 2 had fair, and 1 had poor results. P value was significant for visual analog score and postoperative reduction distance.
  
  
  CONCLUSIONS
  Use of Iso-C navigation allows safe direct fixation of hangman fractures.
authors: Department of Spine and Orthopedic Surgery, Ganga Hospital, Coimbatore, India. sr@gangahospital.com
authors: S
authors: S
authors: Rajasekaran
authors: Vijay Ramappa
authors: VR
authors: Tubaki
authors: Ajoy Prasad
authors: AP
authors: Shetty
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws / Q000592:standards*; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult