Case Report: A case report of unstable Hangman fracture in a eighty year old male.

Sunil Munakomi,Binod Bhattarai

doi:10.12688/f1000research.6799.2

Abstract

Herein we discuss a rare variant of hangman's fracture in an eighty year old male with good Karnofsky performance score. We performed X-ray and magnetic resonance imaging (MRI) of the cervical spine to confirm the diagnosis. The patient was placed on a gentle cervical traction which showed good reduction. Despite being on a resource limited setup, we performed posterior occipitocervical fusion with bone graft fusion followed by early mobilization. A postoperative scan showed good reduction and purchase of the screws. This case highlights the importance of choosing the correct therapeutic attitude for the management of the geriatric population especially in those who do not have any significant co-morbid conditions.

Highlights

Rigid immobilization alone is sufficient for most cases of hangman’s fracture classified as Effendi type I and some of type II
Surgical stabilization and rigid immobilization together is recommended in such cases, such as Levine-Edwards type IIa and III fractures
Since our patient had a good Karnofsky performance score[6], we opted for only posterior fusion so as to minimize the anesthetic risk involved with both anterior and posterior approaches

Summary

Introduction

Rigid immobilization alone is sufficient for most cases of hangman’s fracture (defined as traumatic spondylolisthesis of C2) classified as Effendi type I and some of type II. Since our patient had a good Karnofsky performance score[6], we opted for only posterior fusion so as to minimize the anesthetic risk involved with both anterior and posterior approaches. Fusion of lateral masses of C1 and C3 for hangman’s fractures minimizes risk of vertebral artery injury and displacement of fractured segments into the canal The efficacy of this approach has been validated in a biomechanical study by Chittiboina et al.[17]. Patients with good Karnofsky performance score would benefit from long segment posterior fusion, rather than both anterior and posterior approaches which might increase the intraoperative risk. Managing such patients with a prolonged period of immobilization in a halo imposes a higher risk of nonunion

Conclusion

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