The surgical treatment of unstable Hangman's fracture / 中华骨科杂志

ABSTRACT

Objective To study the treatment strategy and clinical results of surgical management for unstable Hangmans fracture. Methods From May 1994 to December 2001, 52 cases of Hangmans fracture were admitted and recorded in Changhai hospital and Changzheng hospital. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangmans fracture, there were stable fracture (type Ⅰ) in 24 cases, all of whom were treated conservatively, and unstable fracture in 28 cases, who were subdivided into type Ⅱ in 9 cases, type ⅡA in 12 cases and type Ⅲ in 7 cases. The clinical results of 28 cases of unstable Hangmans fracture were analyzed in the study retrospectively. Of 28 unstable fractures, there were 22 males and 6 females, aging from 17 to 62 years with an average of 39 years, and all patients were treated surgically. The interval from injury to the index operation was from one to sixteen days(mean, 4 days). The mechanisms of injury were traffic accident in 13 cases, bruise in 6 cases, falling down in 5 cases, hyperextension in 2 cases and other cause in 2 cases. 12 cases were complicated with neurological symptoms. The patients were given traction from 2 kg to 4 kg increasing gradually; and bedside X-ray examination was taken to confirm the reduction of fracture two to seven days later. 20 cases received anterior fusion and internal fixation with anterior plate; other 8 cases received posterior fusion and internal fixation. The treatment results of anterior and posterior approach group were evaluated. Results One week after operation, X-ray films showed complete reduction of C2,3 dislocation and satisfied internal fixation in all patients. 20 cases of anterior fixation and 4 cases of posterior pedicle screws fixation obtained normal fuction of cervical spine, however, 4 cases using posterior approach, bone grafting and wire fixation had cervical rotational loss of 50% to 70%. Temporary larynx edema occurred in 7 cases, and cured with spray inhalation and dehydration therapy within 72 hours. All of the cases achieved bony fusion; and the neurological function were restored satisfactorily once the fracture and dislocation were reduced. Conclusion Anterior fusion and plate fixation for unstable Hangmans fracture provide an immediate instability, early ambulation and retain the maximal motion range of cervical spine.