Hangman's fracture surgical management with posterior C2-4 fusion: Case description and literature review

BACKGROUND: Hangman's fractures of the C2 verebrae represent approximately 20% of all cervical fractures. They are challenging cases and there is still no consensus regarding the optimal surgical vs nonoperative treatment. CASE DESCRIPTION: A 40-year-old female presented with a C2 bilateral pars articularis fracture. She exhibited a partial spastic quadriparesis. Computed tomography and magnetic resonance imaging showed a C2 “hangman's” fracture with compromise of the C2-3 intervertebral disk. Adequate reduction of the fracture and subaxial stabilization were achieved utilizing C2 transarticular and C3-4 transfacet screws. CONCLUSIONS: The optimal management of unstable hangman's fractures remains controversial. They represent challenging cases, and new treatment options are available. Here, we successfully utilized a C2 transarticular and C3-4 transfacet screw fusion without neurological sequelae.