Hangman’s Fracture: A Biomechanical Comparison of Stabilization Techniques

Abstract

In vitro biomechanical flexibility experiment studying 5 sequential conditions.

To determine the biomechanical differences among 3 fixation techniques after a simulated hangman’s fracture.

Type II hangman’s fractures are often treated surgically with a C2–C3 anterior cervical discectomy, fusion, and plating. Other techniques include direct fixation with C2 pars interarticularis screws or posterior C2–C3 fixation connecting C2 pars screws to C3 lateral mass screws.

Seven cadaveric specimens (Oc–C4) were tested intact, after a simulated hangman’s fracture, and after each fixation technique. Flexion, extension, lateral bending, and axial rotation were induced using nonconstraining torques while recording angular motions stereophotogrammetrically.

Direct screw fixation reduced motion an average of 61% ± 13% during lateral bending and axial rotation compared to the injured state (P < 0.007). However, instability remained during flexion and extension. Posterior C2–C3 rod fixation provided significantly greater rigidity than anterior plate fixation during lateral bending (P < 0.008) and axial rotation (P < 0.04).

Direct fixation of the pars ineffectively limits flexion and extension after a Type II hangman’s fracture. If pars screw fixation can be achieved, posterior C2–C3 fixation more effectively stabilizes a hangman’s fracture than anterior cervical plating.