Image courtesy of our radiology website partner, RiT.
Lateral view of a cervical spine radiograph of an 18-year-old woman who sustained a motor vehicle accident shows anterolisthesis of C2 over C3 (arrowhead) and fracture lines involving the C2 pars interarticulares. The anterior and posterior spinal lines are disrupted.

Hangman’s Fracture

* Traumatic spondylolisthesis of C2
* Fractures of the lamina, articular facets, pedicles or pars interarticulares of C2 with disruption of C2-C3 junction
* Common etiology: fall, diving, motor vehicle collision
* Treatment options depend on the stability of the fracture. Stable injuries without neurological deficit and signs of later instability – usually require only immobilization for a period of time.

Look for:

* If there is anterior translation of C2 over C3, if translation >3 mm with >10 degree angulation — likely unstable
* If there is dislocation of facet joints — likely unstable
* Other associated C-spine pathology (found in up to 1/3 of cases)

Li XF, Dai LY, Lu H, Chen XD. A systematic review of the management of hangman’s fractures. Eur Spine J 2006;15:257-269.