title: Neglected hangman fracture.
abstract: 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.
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Sudhir Kumar
authors.initials: SK
authors.lastname: Srivastava
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Rishi Anil
authors.initials: RA
authors.lastname: Aggarwal
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Pradip Sharad
authors.initials: PS
authors.lastname: Nemade
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Sunil Krishna
authors.initials: SK
authors.lastname: Bhoale
keywords: Anterior-posterior-anterior approach; hangman fracture; neglected hangman fracture