Hangman's fracture
| Hangman's fracture | |
|---|---|
| Classification and external resources | |
 Second cervical vertebra, or epistropheus, from above. |
|
| ICD-10 | S12.1 |
| ICD-9 | 805.02 |
A Hangman's fracture is the colloquial name given to a fracture of both pedicles or pars interarticularis of the axis vertebra (C2).
The mechanism of the injury is forcible hyperextension of the head, usually with distraction of the neck. Traditionally this would occur during judicial hanging, when the noose was placed below the condemned subject's chin. When the subject was dropped, the head would be forced into hyperextension by the full weight of the body, a sufficient force to cause the fracture. However, despite its long association with judicial hangings, one study of a series of such hangings showed that only a small minority of hangings produced a hangman's fracture.[1]
Apart from hangings, the mechanism of injury - a sudden forceful hyperextension centered just under the chin - occurs mainly with deceleration injuries in which the victim's face or chin strike an unyielding object with the neck in extension. The most common scenario would be a frontal motor vehicle accident with an unrestrained passenger or driver, with the person striking the dashboard or windshield with their face or chin. Other scenarios would include falls, diving injuries, and collisions between players in contact sports.
Although a hangman's fracture is unstable, survival from this fracture is relatively common, as the fracture itself tends to expand the spinal canal at the C2 level. It is not unusual for patients to walk in for treatment and have such a fracture discovered on X-rays. Only if the force of the injury is severe enough that the vertebral body of C2 is severely subluxed from C3 does the spinal cord become crushed, usually between the vertebral body of C3 and the posterior elements of C1 and C2.
Treatment of hangman's fractures thus involve reducing any subluxations and stabilizing the spine in a fixed position, usually with a halo vest traction device, to allow the fracture to heal. In cases of non-union of the fracture, surgical stabilization and fusion is usually required.
In deliberate or suicidal hanging, asphyxia is much more likely to be the cause of death due to associated prevertebral swelling.
A common sign is a constricted pupil (Horner's syndrome) on the ipsilateral side due to loss of sympathetic innervation to the eye, caused by damage to the sympathetic trunk in the neck.
[edit] References
- ^ James R, Nasmyth-Jones R., The occurrence of cervical fractures in victims of judicial hanging, Forensic Science International, 1992 Apr;54(1):81-91.
[edit] See also
|
|||||||||||||||||||||||||||||||||||||||||||
 |
This medical article is a stub. You can help Wikipedia by expanding it. |
