Hangman’s Fracture with Concomitant Atlantoaxial Dislocation

Abstract

Background and Importance: Hangman's fracture concomitant with atlantoaxial subluxation is a rare phenomenon. Herein, we reported the victim of a motor vehicle crash with traumatic spondylolisthesis of the axis and atlantoaxial rotary dislocation. Case Presentation: The patient was a 32-year-old female with the chief complaint of severe neck pain. Her neurologic examination was normal, but did reveal mild torticollis. Imaging revealed anterolisthesis of the C2 over C3 with angulation of C1/ C2 and rupture of the C2/ C3 disc, while the integrity of the transverse ligament was preserved. The patient first underwent a partial close reduction for the dislocation followed by the operation focusing on the Hangman's fracture using a 360-degree approach. An anterior discectomy of C2/ C3 with cage and plate insertion was followed by posterior fixation using C1, C3 and C4 lateral mass screws. The one-year follow-up radiography depicted proper fusion and alignment. Conclusion: Paucity of evidence regarding simultaneous atlantoaxial dislocation and Hangman's fracture made its management challenging. The mechanism of injury is probably hyperextension and rotation. Based on our presented case, anteroposterior fixation resulted in a satisfactory longterm outcome, both clinically and radiologically.

Traumatic C2-C3 subluxation with atlanto-axial dislocation managed by posterior approach — A rare case report

“…In three similar cases before ours, one was reported to be reduced after 3 weeks of bidirectional cervical traction and another two cases were managed by open reduction and stabilization [ [16] , [17] , [18] , [19] ].…”

“…Han et al presented Traumatic bilateral atlantoaxial rotatory subluxation with hangman fracture in an adult [ 17 ]. Chaudhary et al presented a case of Traumatic atlantoaxial dislocation with Hangman fracture [ 18 ]. Faghih-Jouybari M et al presented a case of Hangman's Fracture with Con-comitant Atlantoaxial Dislocation [ 19 ].…”