title: Double hangman's fracture.
abstract: METHODS
  Clinical case report and review of the literature.
  
  
  OBJECTIVE
  To report a very rare case of bipedicular fracture of C2, C3 along with traumatic spondylolisthesis of the C2, C3 vertebral bodies together over C4 without any neurological deficits.
  
  
  BACKGROUND
  Cervical spine injury is a potentially fatal and debilitating incident because of the risk of damage of the cervical spinal cord. Hangman's fracture comprises 4% to 7% of all traumatic cervical spine fractures. Attempting closed reduction in a neurologically intact patient may cause the development of new deficits during time of traction, especially in the case of compromised neural canal. The management should be aimed at providing a stable well-aligned spine without causing any new neurological deficits.
  
  
  METHODS
  A 35-year-old female had a motor vehicle accident and her forehead collided against the ground, causing hyperextension-compression type injury of the cervical spine that resulted in complaints of neck pain on movement. Cervical spine plain radiographs revealed spondylolisthesis of C2, C3 vertebral bodies together over C4 with bipedicular fracture of C2, C3. A computed tomographic scan confirmed these fractures. Magnetic resonance imaging further demonstrated spondylolisthesis without any spinal cord compression or signal abnormality. An anterior C2, C3 and C3-C4 cervical fusion was performed with iliac crest tricortical strut grafting and anterior cervical plating. The patient was turned to a prone position on the striker bed and posterior fixation was performed with lateral mass screws of C1 and C5.
  
  
  RESULTS
  Reduction of the spondylolisthesis was achieved with gradual cervical traction in an awake intubation followed by 360º of fusion with both anterior and posterior fixation.
  
  
  CONCLUSIONS
  Bipedicular fracture of C2, C3 along with traumatic spondylolisthesis of the C2, C3 vertebral bodies together over C4 without any neurological deficits is very rare injury and needs methodical 360º fixation.
authors.affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500082, India.
authors.forename: Mohana Rao
authors.initials: MR
authors.lastname: Patibandla
authors.forename: Vijayasaradhi
authors.initials: V
authors.lastname: Mudumba
authors.forename: Vamsi Krishna
authors.initials: VK
authors.lastname: Yerramneni
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome