Jun Zhou, MD, PHD; Huilin Yang, MD, PHD; Lian Chen, Zhigang Zhang; Cheng Ji, MD
The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
Poster presented at NASS 24th Annual meeting. Published in The Spine Journal 9 (2009) 143S.
BACKGROUND CONTEXT: Since Hangman's fracture was initially noted in 1965 by Schneider et al, anatomy and the proposed mechanism of this injury have been well documented; however, controversy regarding the optimal treatment of it has continued to linger.
PURPOSE: To discuss the selection of therapy for Hangman's fracture and determine the treatment efficacy.
STUDY DESIGN/SETTING: Retrospective design.
PATIENT SAMPLE: A total of 29 patients from 2002-2008, male 20 cases, femal 9 cases, with a mean age of 39 years (16-57 years).
OUTCOME MEASURES: Levine-Edwards system was used to classify the fractures, and radiographs were used to determine motion, angulation and fracture union.
METHODS: Type I, Type II and part of Type IIA Hangman's fractures were treated with early collar or halo-vest immmobilization after traction reduction, buy Type IIA with an angulation of greater than or equal to 12º between C2 and C3 and Type III fractures were treated with surgical procedure (posterior occipital fusion or C1-3 fusion).
RESULTS: There were a total of 8 Type 1, 14 Type II, 5 Type IIA and 2 Type III Hangman's fractures. Three patients presented with neurologic deficits caused by spinal cord injury, nine patients were found to have associated spinal fractures. The mean follow-up was 18 months (4-37 months). All fractures progressed to union. There was no implant failure (loosening, bending, or breakage of screws).
CONCLUSIONS: Early collar or halo-vest immobilization after traction reduction of Type I, Type II and part of Type IIA Hangman's fractures is an effective method of management. Type IIA with an angulation of greater than or equal to 12º between C2 and C3 and Type III fracture may require posterior occipital fusion or C1- 3 fusion.
FDA DEVICE/DRUG STATUS: Halo-Vest: Approved for this indication; Sofamor Transpedicular Internal Fixation System: Approved for this indication.