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Bartosz Godlewski, Maciej Dominiak, Adam Bebenek Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed â St. Raphael Hospital, Cracow, PolandCorrespondence: Bartosz Godlewski, Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed â St. Raphael Hospital, ul. Adama Bochenka 12, Cracow, 30-693, Poland, Tel/Fax +48 12 3855634, Email bartoszgodlewski@wp.plIntroduction: Hangmanâs fracture, also known as traumatic spondylolisthesis of the axis, is defined as a bilateral fracture of the C2 pars interarticularis. In 1965, Schneider used this term to describe a pattern of similarities seen in fractures associated with judicial hangings. However, this fracture pattern is only observed in approximately 10% of injuries associated with hangings.Case Report: We present a case of an atypical hangmanâs fracture caused by a headlong dive into a swimming pool and striking the poolâs bottom. The patient had undergone surgery at another centre, where posterior C2-C3 stabilisation was performed. Due to the presence of screws in the C1-C2 joint spaces, the patient could not perform rotational movements of the head. Anterior stabilization to prevent C2 dislocation against C3 was also not performed, and appropriate spinal stability was not ensured. Our decision to reoperate was motivated, among other factors, by our intention to restore rotational head movements. The revision surgery was performed from both an anterior and posterior approach. After the surgery, the patient was able to rotate his head while maintaining cervical spine stability. The case presented here represents not only a unique example of an atypical C2 fracture but also highlights a fixation technique that provided the necessary stability for successful fusion. The utilized method restored functional rotational movement of the head, thus preserving the patientâs quality of life, which is of paramount importance considering the patientâs age.Conclusion: The decision-making process regarding the technique for treating hangmanâs fractures, especially atypical fractures, should account for the patientsâ quality of life after the operation. The preservation of as much of the physiological range of motion as possible with maintained spinal stability should be the goal of therapy in every case.Keywords: hangmanâs fracture, traumatic spondylolisthesis of C2, axis fracture, cervical spine, fusion |
