Transoral Fusion With Internal Fixation in a Displaced Hangman's Fracture

Wilson, Adrian; Marshall, Robert W.; Ewart, M. C.

doi:10.1097/00007632-199902010-00022

Cited by 41 publications

(40 citation statements)

References 17 publications

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“…In this instance, we advocate an anterior C2-3 discectomy and fusion with optional plating. The anterior approach has been confirmed to be an effective strategy for hangman's fracture by many authors [8,9,11]. A high anterior approach may impose a risk to vital structures, especially the facial and hypoglossal nerves, branches of the external carotid, the contents of the carotid sheath and the superior laryngeal nerve.…”

Section: Discussionmentioning

confidence: 99%

Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture

Zhao

Yuan

2008

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 99%

Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture

Zhao

Yuan

2008

International Orthopaedics (SICOT)

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“…Thus, it is worth considering whether the anterior approach may become an alternative to the posterior approach. Anterior fusion with iliac graft and plates at C2-3 has been confirmed as an effective management for Hangman's fracture [12,23]. Importantly, complications related with the anterior approach including injury to the hypoglossal nerve and superior laryngeal nerve are no longer the hindrances for proficient and experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Anterior C3 corpectomy and fusion for complex Hangman’s fractures

Ma¹,

Yuan

Wang

et al. 2012

International Orthopaedics (SICOT)

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“…Methods of surgical stabilization include anterior surgery such as anterior cervical discectomy and fusion (ACDF) at C2-3; posterior surgeries such as C-2 transpedicular screw fixation, C2-3 fixation, extensive arthrodesis from C-1 to C-3, and occipitocervical fixation; and surgery by both anterior and posterior approaches. 1,10,13,26 The use of the various surgical treatments has failed to generate a consensus on the optimal management protocol for unstable hangman's fractures. 10 The purposes of this study were to assess healing after surgical reduction and fixation and to propose a guideline for the treatment of hangman's fractures accompanied by discoligamentous instability or combined fractures.…”

mentioning

confidence: 99%

“…Disappointing results of conservative management have led surgeons to advocate early surgical intervention for unstable high cervical fractures, to reduce and hasten healing of the fracture. 5,13,21,24,26 In the present study, we initially examined cervical MR images in all patients with a hangman's fracture and performed surgical stabilization in cases of unstable fractures (Types II, IIa, and III) that involved definite discoligamentous injuries. All patients had documented postoperative bony healing without additional surgeries.…”

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confidence: 99%

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Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures

Shin

Kim

Cho

et al. 2013

SPI

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Object Several controversial issues arise in the management of unstable hangman's fractures. Some surgeons perform external reduction and immobilize the patient's neck in a halo vest, while others perform surgical reduction and internal fixation. The nonsurgical treatments with rigid collar or halo vest immobilization present problems, including nonunion, pseudarthrosis, skull fracture, and scalp laceration and may also fail to achieve anatomical realignment of the local C2–3 kyphosis. With recent advances in surgical technique and technology, surgical intervention is increasingly performed as the primary treatment in high cervical fractures. The outcomes of such surgeries are often superior to those of conservative treatment. The authors propose that surgical intervention as a primary management for hangman's fracture may avoid risks inherent in conservative management when severe circumferential discoligamentous instability is present and may reduce the risk of catastrophic results at the fracture site. The purposes of this study were to assess fracture healing following expedient reduction and surgical fixation and to propose a guideline for treatment of unstable hangman's fractures. Methods From April 2006 to December 2011, the authors treated 105 patients with high cervical fractures. This study included 23 (21.9%) of these patients (15 men and 8 women; mean age 46.4 years) with Type II, IIa, and III hangman's fractures according to the Levine and Edwards classification. The patient's age, sex, mechanism of injury, associated injuries, neurological status, and complications were ascertained. The authors retrospectively assessed the clinical outcome (Neck Disability Index), radiological findings (disc height, translation, and angulation), and bony healing. Results The average follow-up period was 28.9 months (range 12–63.2 months). The overall average Neck Disability Index score at the time of this study was 6.6 ± 2.3. The average duration of hospitalization was 20.3 days, and fusion was achieved in all cases by 14.8 ± 1.6 weeks after surgery, as demonstrated on dynamic radiographs and cervical 3D CT scans. The mean pretreatment translation was 6.9 ± 3.2 mm, and the mean postoperative translation was 1.6 ± 1.8 mm (mean reduction 5.2 ± 3.1 mm). The initial angulation was 4.7° ± 5.3° and the postoperative angulation was 2.5° ± 1.8° (mean reduction 6.1° ± 5.3°). The preoperative and postoperative values for translation and angulation differed significantly (p < 0.05). The overall C2–3 disc height was 6.7 ± 1.2 mm preoperatively, whereas 3 months after surgery it was 6.4 ± 1.1 mm. These values did not differ significantly (p = 0.0963). Conclusions The authors observed effective reduction and bony healing in cases of unstable hangman's fractures after fixation, and all patients experienced favorable clinical outcomes with neck pain improvement. The protocols allowed for physiological reconstruction of the fractured deformities and avoided external fixation. The authors suggest that posterior reduction and screw fixation should be used as a primary treatment to promote stability of hangman's fracture in the presence of discoligamentous instability or combined fractures.

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Transoral Fusion With Internal Fixation in a Displaced Hangman's Fracture

Cited by 41 publications

References 17 publications

Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture

Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture

Anterior C3 corpectomy and fusion for complex Hangman’s fractures

Primary surgical management by reduction and fixation of unstable hangman's fractures with discoligamentous instability or combined fractures

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