Hangman’s Fracture with Concomitant Atlantoaxial Dislocation

Hangman’s fracture concomitant with atlantoaxial subluxation is a rare phenomenon. Herein we report the victim of a motor vehicle crash with traumatic spondylolisthesis of the axis and atlantoaxial rotary dislocation. 

The patient was a 32 year old female with the chief complaint of severe neck pain. Her neurologic examination was normal but did reveal mild torticollis. Imaging revealed anterolisthesis of the C2 over C3 with angulation of C1/ C2 and rupture of the C2/ C3 disc while the integrity of the transverse ligament was preserved. The patient first underwent a partial close reduction for the dislocation followed by the operation focusing on the Hangman’s fracture using a 360-degree approach. An anterior discectomy of C2/ C3 with cage and plate insertion was followed by posterior fixation using C1, C3 and C4 lateral mass screws. The one-year follow-up radiography depicted proper fusion and alignment. 

Paucity of evidence regarding simultaneous atlantoaxial dislocation and Hangman’s fracture made its management challenging. The mechanism of injury is probably hyperextension and rotation. Based on our presented case, anteroposterior fixation resulted in a satisfactory long-term outcome, both clinically and radiologically.