Cervical Spine Orthopedics I Practice Exam

Describe a Hangman fracture and its typical mechanism.

Bilateral pars interarticularis fracture of C2 with anterior subluxation of C2 on C3 due to hyperextension injury Burst fracture of C1 from axial load Fracture of the odontoid base Fracture of C5 facet

Correct Answer:

Bilateral pars interarticularis fracture of C2 with anterior subluxation of C2 on C3 due to hyperextension injury

Explanation:

Hangman fracture is a traumatic spondylolysis of the axis (C2) with bilateral fractures through the pars interarticularis and forward (anterior) displacement of C2 on C3. This pattern arises from a hyperextension injury to the neck, often with an axial load, which drives the posterior elements to fail on both sides of C2 and allows C2 to translate forward relative to C3. It’s a distinct mechanism from other cervical injuries: a Jefferson fracture is a burst of C1 from axial load, a base fracture involves the dens, and a facet fracture at a lower level involves the facet joints.

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