Traumatic atlantoaxial dislocation with Hangman fracture

Background contextTraumatic bilateral-atlantoaxial dislocations are rare injuries. Hangman fractures, conversely, represent 4% to 7% of all cervical fractures and frequently involve a combination C1–C2 fracture pattern. Presently, there is no report in the English literature of a traumatic C2-spondylolisthesis associated with a C1–C2 rotatory dislocation. This injury complex cannot be cataloged using current classification schemes and no established treatment recommendations exist.PurposeTo report a unique case of a Hangman fracture associated with bilateral C1–C2 rotatory-dislocation, which does not fit into existing classification systems, and discuss our treatment approach.Study designA clinical case report and review of the literature.MethodsChart review and analysis of relevant literature. There were no study-specific conflicts of interest.ResultsA 26-year-old man sustained a traumatic C2-spondylolisthesis along with C1–C2 rotatory subluxation in an automobile collision. The patient was originally placed in a halo crown and vest and then taken for an open reduction and stabilization through a posterior approach for persistent C1–C2 subluxation. The patient is currently 16 months postoperative and back to work as a plumber.ConclusionsThe injury complex encountered cannot be described using the available classification systems. Our treatment included initial stabilization with halo placement, followed by a posterior C1, C2, and C3 segmental reduction and fixation resulting in radiographic fusion and a good clinical outcome.