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Hangman's fracture

Hangman's fracture is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Hangman's fracture rather than just read about it. In short: Hangman's fracture is the colloquial name given to a fracture of both pedicles, or partes interarticulares, of the axis vertebra (C2). Causes The injury mainly occurs from falls, usually in elderly adults, and motor accidents mainly due to impacts of high force causing extension of the neck and great axial load onto the C2 vertebra.

Hangman's fracture — main illustration
Hangman's fracture — illustration

Key takeaways

  • Hangman's fracture belongs to science; place it in that map before memorising details.
  • Learn the definition first, then one example that makes the definition concrete.
  • Connect Hangman's fracture to a quantity you can measure, compute or draw — that is where exam questions come from.
  • Reproduce the core statement of Hangman's fracture from memory before moving on to harder problems.

Reference excerpt

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

Causes

The injury mainly occurs from falls, usually in elderly adults, and motor accidents mainly due to impacts of high force causing extension of the neck and great axial load onto the C2 vertebra. In a study based in Norway, 60% of reported cervical fractures came from falls and 21% from motor-related accidents. According to the Agency for Healthcare Research and Quality (AHRQ), the group under the highest risk of C2 fractures are elderly people within the age group of 65–84 (39.02%) at risks of falls (61%) or motor accidents (21%) in metropolitan areas (94%). There were 203 discharges from the age group 1-17; 1,843 from 18- to 44-year-olds; 2,147 from 45- to 64-year-olds, 4,890 from 65- to 84-year-olds, and 3440 from 85+-year-olds. Females accounted for 54.45% of occurrences while males accounted for the other 45.38%.

Mechanisms

The mechanism of the injury is forcible hyperextension of the head, usually with distraction of the neck. This commonly occurs 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. 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. 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 is 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 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.

Prevention

Car crashes Most commonly this can occur during a car accident. A person involved in a car crash, especially with no seat belt, can slam their chin against the steering wheel, dashboard, or windshield, causing the hyperextension to occur.

Contact sports Falling and colliding with other people in a contact sport can also cause this fracture. Falling causes the weight of the body to force hyperextension. In full-contact sports such as American football and Rugby, diving for the ball can lead a player to land on his head, forcing the neck into hyperextension. The further piling of players on top of an injured player adds more weight and can lead to further occurrences of this fracture.

Treatment

Non-surgical or surgical Hangman's fractures treatments are both non-surgical and surgical.

Benefits of surgical hangman's fracture treatment Sasso also observed that people who underwent surgical treatment will not be affected by pin site infections, brain abscesses, facet joint stiffness, loss of spinal alignment, and skin breakdown. Another study concerns the surgical treatment of the ring of axis conducted by Barsa and coauthors (2006) based on 30 cases within 41 patients treated by using anterior cervical fixation and fusion and 11 cases treated by a posterior CT.

Result of the surgical treatment As a result, Barsa and coauthors showed that the result of fracture fusion reduced after one year but only one patient died of other disease during the follow-up. Hakalo and Wronski (2008) showed the benefits of operative treatment such as using transoral C2-C3 discectomy with plate-cage stabilization or posterior direct pars screw repair for the reducing and healing process. 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.

Epidemiology

The C2 fracture accounts for nearly 19% of spinal fractures and 55% of cervical fractures (in patients with head injury). Within C2 fractures, the hangman's fracture accounts for 23% of occurrences while the odontoid or dens fracture accounts for 55% of them.

Society

Statistics from the AHRQ show that there were 12,532 hospital discharges from C2 fractures in the US during 2010. The mean healthcare costs were $17,015 and the "national bill" or the aggregate charges were $749,553,403. Only 460 in-hospital deaths related to the C2 fracture occurred. From 2000 to 2010, the number of discharges has increased from 4,875 to 12,532, almost a 250 percent increase. Mean health care costs went from $24,771 to $59,939.

See also Cervical fracture Cervical vertebrae

References

External links

Illustrations

Hangman's fracture illustration
Hangman's fracture: X-ray of the cervical spine with a Hangman's fracture. Left without, right with annotation. It can be seen clearly that C2 (red outline) is moved forward with respect to C3 (blue outline).
X-ray of the cervical spine with a Hangman's fracture. Left without, right with annotation. It can be seen clearly that C2 (red outline) is moved forward with respect to C3 (blue outline).
Hangman's fracture: A demonstration of a common mechanism of a hangman's fracture in a car accident
A demonstration of a common mechanism of a hangman's fracture in a car accident
Hangman's fracture: The pie chart shows the incidence of C2 fractures according to age groups. For the <17 age group, there were 203 incidents. For ages 18-44 there were 1843. For 45-64 there were 2147. For 65-84 there were 4890 and for 85+ there were 3440 incidents. A total of 12,532 discharges in America were reported in 2010.
The pie chart shows the incidence of C2 fractures according to age groups. For the <17 age group, there were 203 incidents. For ages 18-44 there were 1843. For 45-64 there were 2147. For 65-84 there were 4890 and for 85+ there were 3440 incidents. A total of 12,532 discharges in America were reported in 2010.
Hangman's fracture: The graph shows the trend of hospital charges and number of discharges over the span of 12 years in the U.S.A. In 1998, hospital costs were $24,423 with 4,991 discharged. In 2010 hospital charges increased to 59,939 with 12,532 discharged.
The graph shows the trend of hospital charges and number of discharges over the span of 12 years in the U.S.A. In 1998, hospital costs were $24,423 with 4,991 discharged. In 2010 hospital charges increased to 59,939 with 12,532 discharged.

Worked examples

Example 1 — a first encounter with Hangman's fracture

Start with the simplest possible case. Write down what Hangman's fracture claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Hangman's fracture before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Hangman's fracture ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Hangman's fracture

In research
Hangman's fracture appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry
Engineering practice reuses Hangman's fracture in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom
Hangman's fracture is common in secondary-school and first-year university syllabi. It links to neighbouring topics Bone fractures, Cervical spine fracture, Injuries of neck, so understanding it makes those chapters shorter.
In everyday life
Look for Hangman's fracture outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.
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How to study Hangman's fracture in 20 minutes

  1. Read the reference excerpt below once, without taking notes.
  2. Close the page and write down what Hangman's fracture means in your own words.
  3. Compare your version with the excerpt and mark what you missed.
  4. Work through the three examples above with pen and paper.
  5. Explain Hangman's fracture out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Hangman's fracture in simple terms?

Hangman's fracture is the colloquial name given to a fracture of both pedicles, or partes interarticulares, of the axis vertebra (C2). Causes The injury mainly occurs from falls, usually in elderly adults, and motor accidents mainly due to impacts of high force causing extension of the neck and gre…

Why does Hangman's fracture matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Hangman's fracture?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Hangman's fracture.

Tags

  • Bone fractures
  • Cervical spine fracture
  • Injuries of neck

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