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122: HANGMAN’S FRACTURE

Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYM

  • Cervical spondylolisthesis

ICD-9-CM CODES

  • 738.4 Acquired spondylolisthesis

  • 756.12 Spondylolisthesis congenital

  • 805.02 Closed fracture of second cervical vertebra

ICD-10-CM CODES

  • M43.10 Spondylolisthesis, site unspecified

  • Q76.2 Congenital spondylolisthesis

  • S12.100A Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture

  • S12.101A Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

PATIENT PRESENTATION

Patient is a 58-year-old woman involved in a motor vehicle accident. Patient had a bilateral C2 pars interarticularis fracture. The surgeon and patient agreed on conservative management. The patient presents 3 months later with decreased range of motion of the cervical spine and muscle spasms. The patient does not have any dizziness or upper or lower extremity symptoms.

KEY FEATURES

Description

  • Anterior (forward) translation of a vertebra

  • C2 vertebra anterior translated on C3 with a fracture of C2 pedicles

  • Fracture of the pedicles on the C2 vertebra

  • Slipping of the vertebra in relationship to the vertebra below

  • Neurogenic claudication

  • Fracture widens at the pars

Essentials of Diagnosis

  • Diagnosis made by X-ray

  • Clinical examination may find step deformity

  • Dermatome/myotome pattern

  • Stability of the cervical spine is critical

  • Spondylolysis: Fracture without displacement

FIGURE 122-1

This sagittal CT reconstruction reveals injury to C2 known as a hangman’s fracture. (From Malone TR, Hazle C, Grey ML. Imaging in Rehabilitation. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 122-2

The axial image reveals the bilateral fracture pattern associated with a hangman’s fracture. (From Malone TR, Hazle C, Grey ML. Imaging in Rehabilitation. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Instability

  • Individual may not know they have a fracture immediately following an accident

  • Avoid extension positions that increase symptoms

Demographics

  • After trauma

  • Suicidal hanging

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Cervical, shoulder, arm, and upper-extremity pain and paresthesia, often radiating into lower extremities if central cord involved

  • Constricted pupil (Horner sign)

  • Stiffness along the spine

  • Headaches

  • Pain in the cervical spine worsens with extension

  • Diminished sensation, motor control, reflexes in the distribution of involved nerve

  • Neurogenic claudication

Functional Implications

  • May cause death

  • Difficulty maintaining standing posture secondary to neck and arm pain

  • Inability to sleep flat on the back without a pillow

  • Weakness with lifting

  • Loss of ...

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