Type IIa Hangman's fracture with pure distraction: not your typical type IIa fracture

Abstract

A 57-year-old woman sustained a rare type IIa hangman's fracture after being involved in a high-speed motor vehicle accident. A computed tomographic scan of the cervical spine was performed and revealed fractures bilaterally through the pars interarticularis with an uniform distraction without angulation of the C2–C3 disc space (Fig. 1). The patient was taken to the operating room for application of a halo vest. Postoperatively, a magnetic resonance imaging of the cervical spine was performed demonstrating disruption of the anterior longitudinal ligament, posterior longitudinal ligament, and persistent C2–C3 disc space distraction (Fig. 2, Fig. 3). This type IIa variant could not be treated with halo immobilization, the favored treatment for type IIa fractures, therefore was treated with direct C2 transpedicular lag screws (Fig. 4). Fig. 2Sagittal T2-weighted magnetic resonance imaging demonstrating distraction at the C2–C3 disc space with disruption of the posterior longitudinal and anterior longitudinal ligaments. View Large Image Figure Viewer Download Hi-res image Fig. 3Sagittal T2 STIR magnetic resonance imaging demonstrating distraction at the C2–C3 disc space with disruption of the posterior longitudinal and anterior longitudinal ligaments. View Large Image Figure Viewer Download Hi-res image Fig. 4Postoperative lateral cervical spine radiograph demonstrating traspedicular C2 screws with reduction of the C2–C3 disc space. View Large Image Figure Viewer Download Hi-res image