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Neglected hangman fracture.

Srivastava SK, Aggarwal RA, Nemade PS, Bhoale SK - J Craniovertebr Junction Spine (2015 Oct-Dec)

Bottom Line: 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.The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India.

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.

No MeSH data available.


Related in: MedlinePlus

Dynamic X rays showing absence of any significant C2-C3 mobility
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Figure 2: Dynamic X rays showing absence of any significant C2-C3 mobility

Mentions: A 30-year-old man, manual laborer by occupation had fallen from 20 feet height. He had acute pain in the neck and took treatment in the form of over the counter medication. Over 12 weeks, he had persistent pain and developed progressive difficulty in walking. On presentation to the OPD, he was having tenderness on the upper cervical spine and severe limitation of cervical spine movements in all directions. He had spasticity and exaggerated deep tendon reflexes in all 4 extremities, however the muscle power and sensation were normal. The plantar response was extensor. Radiograph revealed a type IIA hangman fracture (Levine and Edward modification of Effendi classification) with localized C2-C3 kyphosis of 33° [Figure 1]. Dynamic radiographs did not reveal significant C2-C3 mobility [Figure 2]. Computed tomography (CT) scan revealed fracture of pars interarticularis of C2 with spondylolisthesis of C2 over C3. Magnetic resonance imaging revealed the compression of epidural space posterior to C3 with intensity changes in the odontoid process [Figure 3]. Preoperative traction was avoided and the patient was taken for surgery under GA. After the application of Gardner-Wells tongs, gentle reduction maneuver was attempted; however the reduction could not be achieved. A three-staged surgery in single setting was done:


Neglected hangman fracture.

Srivastava SK, Aggarwal RA, Nemade PS, Bhoale SK - J Craniovertebr Junction Spine (2015 Oct-Dec)

Dynamic X rays showing absence of any significant C2-C3 mobility
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660500&req=5

Figure 2: Dynamic X rays showing absence of any significant C2-C3 mobility
Mentions: A 30-year-old man, manual laborer by occupation had fallen from 20 feet height. He had acute pain in the neck and took treatment in the form of over the counter medication. Over 12 weeks, he had persistent pain and developed progressive difficulty in walking. On presentation to the OPD, he was having tenderness on the upper cervical spine and severe limitation of cervical spine movements in all directions. He had spasticity and exaggerated deep tendon reflexes in all 4 extremities, however the muscle power and sensation were normal. The plantar response was extensor. Radiograph revealed a type IIA hangman fracture (Levine and Edward modification of Effendi classification) with localized C2-C3 kyphosis of 33° [Figure 1]. Dynamic radiographs did not reveal significant C2-C3 mobility [Figure 2]. Computed tomography (CT) scan revealed fracture of pars interarticularis of C2 with spondylolisthesis of C2 over C3. Magnetic resonance imaging revealed the compression of epidural space posterior to C3 with intensity changes in the odontoid process [Figure 3]. Preoperative traction was avoided and the patient was taken for surgery under GA. After the application of Gardner-Wells tongs, gentle reduction maneuver was attempted; however the reduction could not be achieved. A three-staged surgery in single setting was done:

Bottom Line: 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.The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India.

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.

No MeSH data available.


Related in: MedlinePlus