The modern approach of hangman's fracture.

Upper cervical spine injuries associated with the characteristic alterations of the axis are termed by the international literature as hangman's fracture (HF). The specific changes of the clinical picture include fracture of the bilateral pedicles of the axis, dislocation of the arch, luxation and discopathy between the second and third (C2-C3) vertebrae, eventually other accessory fractures of vertebrae C2-C3 (Fig. 1). There are two kinds of it, i.e. (i) one of a hyperextensive-distractive mechanism with the very severe neurological lesion leading to the classical injury due to hanging and (ii) one of a hyperextensive-compressive mechanism without neurological lesion of current traffic injuries or with slight neurological symptoms. The latter more often occurring type of injury encompasses a relatively wide range, which can be classified into three types: The stable injuries can be managed by conservative treatment, the unstable ones by Halo treatment or ventral surgical therapy meeting the up-to-date requirements. Prognosis is good. The authors have been the first in Hungary to present a critical and detailed survey of the world literature and their 11-year experience, in the form of a clinical study.