Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Surgical Management of the Hangman's Fracture in the Twelve Cases: Case Series
On İki Vakada Hangman Kırığının Cerrahi Tedavisi: Olgu Serisi
Özgür AKŞANa, Mehmet SEÇERb
aDepartment of Neurosurgery, İstanbul Aydın University Faculty of Medicine, İstanbul, Türkiye
bDepartment of Neurosurgery, Alanya Alaaddin Keykubat University Alanya Training and Research Hospital, Antalya, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(1):8-13
doi: 10.5336/medsci.2022-93200
Article Language: EN
Full Text
ABSTRACT
 Objective: Hangman's fracture is a condition characterized by anterior displacement of C2 upon C3 with a fracture in the C2 where the neural arch attaches to the vertebral corpus as a result of axial loading of the head accompanying hyperextension. Material and Methods: From January 2015 to January 2022, analysis retrospectively included 12 patients operated by hangman's fracture. The lesions were considered to be a hangman's fracture after computed tomography findings. The clinical condition was classified on the basis of American Spinal Injury Association scale and visual analog scale. All patients underwent C2-3 posterior fusion. All patients had at 6 and 12 months follow-up cervical computed tomography, which were used to assess bony union, final displacement, and angulation. Results: 5 of the patients were males and 7 females with the age range of 22-82 (mean age 49). The cause of trauma was in vehicle accident in 4 patients, falling from a height in 6 patients, and falling after slipping in the bathroom in 2 patient. All patients complained of neck pain. Except for 2 patients with upper extremity paralysis and spastic tetraparesis, 10 patients had no neurological deficit. According to the Levine and Edwards typical hangman's fracture classification, 7 had Type II fractures, while one patient had Type III fractures. According to the Li-Wang atypical hangman's fracture classification, 4 were Type B. Conclusion: Radiological evaluation and subsequent classification are very important in management. Posterior C2-3 fusion is a very effective surgical way.

Keywords: Axis; hangman's fracture; traumatic spondylolisthesis; upper cervical trauma
ÖZET
 Amaç: Hangman kırığı, hiperekstansiyona eşlik eden başın eksenel yüklenmesi sonucu nöral arkın vertebral korpusa tutunduğu C2'de bir kırık ile C2'nin C3 üzerine anterior yer değiştirmesi ile karakterize bir durumdur. Gereç ve Yöntemler: Ocak 2015'ten Ocak 2022 tarihine kadar geriye dönük olarak, hangman kırığı ile ameliyat edilen 12 hasta analiz edildi. Bilgisayarlı tomografi bulgularından sonra lezyonlar hangman kırığı olarak kabul edildi. Klinik durum Amerikan Spinal Kord Yaralanması Derneği skalası ve görsel analog skalasına göre sınıflandırıldı. Tüm hastalara C2-3 posterior füzyon uygulandı. Tüm hastaların 6 ve 12 aylık takiplerinde; kemik kaynaması, nihai yer değiştirme ve açılanmayı değerlendirmek için kullanılan servikal bilgisayarlı tomografi vardı. Bulgular: Yaşları 22-82 (ortalama yaş 49) olan hastaların 5'i erkek, 7'si kadındı. Travma nedeni 4 hastada trafik kazası, 6 hastada yüksekten düşme ve 2 hastada banyoda kayma sonucu düşme idi. Tüm hastalar boyun ağrısından şikâyetçiydi. Ekstremite paralizisi ve spastik tetraparezi kaybı olan 2 hasta dışında 10 hastada defisit yoktu. Levine-Edwards tipik hangman kırık sınıflamasına göre 7 hastada Tip II, 1 hastada Tip III kırık vardı. Li-Wang atipik hangman kırık sınıflamasına göre 4 tanesi Tip B idi. Sonuç: Tedavide radyolojik değerlendirme ve sonrasındaki sınıflandırma çok önemlidir. Posterior C2-3 füzyonu çok etkili bir cerrahi yöntemdir.

Anahtar Kelimeler: Aksis; hangman kırığı; travmatik spondilolistezis; üst servikal travma
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