Causes and Mechanisms
- Hangman's fracture mainly occurs from falls in elderly adults and motor accidents with high-force impacts.
- In a study in Norway, 60% of reported cervical fractures were from falls and 21% from motor-related accidents.
- Elderly people aged 65-84 are at the highest risk of C2 fractures, with falls accounting for 61% and motor accidents for 21%.
- Metropolitan areas have a higher prevalence of C2 fractures, with 94% of cases occurring in these areas.
- Females account for 54.45% of C2 fractures, while males account for 45.38%.
- Hangman's fracture is caused by forcible hyperextension of the head, usually with distraction of the neck.
- It commonly occurs in judicial hangings, frontal motor vehicle accidents, falls, diving injuries, and contact sports.
- Hangman's fracture is unstable but survival is relatively common.
- Severe force can crush the spinal cord between the vertebral bodies of C3 and the posterior elements of C1 and C2.
- Only a small minority of hangings produce a hangman's fracture.

Prevention
- Car accidents can cause hangman's fracture when the chin slams against the steering wheel, dashboard, or windshield.
- Not wearing a seat belt increases the risk of hyperextension injuries in car crashes.
- Falling and colliding with others in contact sports can lead to hangman's fracture.
- The weight of the body forces hyperextension during falls in contact sports.
- Full-contact sports like American football and Rugby increase the risk of hangman's fracture due to diving for the ball and piling of players.

Treatment
- Hangman's fracture can be treated with both non-surgical and surgical approaches.
- Surgical treatment reduces the risk of complications such as pin site infections, brain abscesses, and loss of spinal alignment.
- Anterior cervical fixation and fusion or posterior CT can be used for surgical treatment.
- Fracture fusion decreases after one year, but the overall outcome is positive.
- Operative treatment, such as transoral C2-C3 discectomy with plate-cage stabilization or posterior direct pars screw repair, aids in reducing and healing the fracture.

Epidemiology
- C2 fractures account for nearly 19% of spinal fractures and 55% of cervical fractures in patients with head injury.
- Hangman's fracture accounts for 23% of C2 fractures, while odontoid or dens fracture accounts for 55%.
- In the US, there were 12,532 hospital discharges related to C2 fractures in 2010.
- Mean healthcare costs for C2 fractures increased from $24,771 to $59,939 from 2000 to 2010.
- The number of discharges for C2 fractures increased by almost 250% during the same period.
- Hospital charges and the number of discharges for C2 fractures increased from 1998 to 2010 in the US.
- In 2010, there were 12,532 discharged cases of C2 fractures, with a mean healthcare cost of $17,015.
- The national bill or aggregate charges for C2 fractures in 2010 were $749,553,403.
- Only 460 in-hospital deaths were related to C2 fractures.
- The trend of hospital charges and discharges indicates an increasing burden of C2 fractures on the healthcare system.

Classification, Symptoms, and Diagnosis
- ICD-10: S12.1
- ICD-9-CM: 805.02
- Trauma to the neck, high-impact accidents, sports injuries, falls from heights, and physical assault are causes of hangman's fracture.
- Symptoms include neck pain, limited range of motion, numbness or tingling in the arms, weakness in the arms, and difficulty swallowing or breathing.
- Diagnosis involves physical examination, X-rays of the cervical spine, CT scan or MRI, neurological evaluation, and evaluation of associated injuries.
- Treatment includes immobilization with a cervical collar or brace, pain management with medications, surgery for severe cases, physical therapy and rehabilitation, and follow-up imaging to monitor healing progress.

Hangman's fracture (Wikipedia)

Hangman's fracture is the colloquial name given to a fracture of both pedicles, or partes interarticulares, of the axis vertebra (C2).

Hangman's fracture
CT scan of hangman's fracture
Specialty	Orthopedic