Hangman' s Fracture With Unilateral Locked Facet: A Rare Case

Objective: The hangman's fracture and traumatic spondylolisthesis of axis are terms used to explain a specific C2 posterior column fracture. Although true mechanism of hangman's fracture is hyperextension and distraction of upper cervical spine with severe cord injury, traumatic axis pedicle fractures are caused by extension and compression of upper cervical spine usually with less probability of cord injury. Herein we describe a case who suffered from C2 bipedicular fractures with left unilateral C2-3 locked facet. Case Description: A 19-year-old young woman was seen at emergency room after a high momentum car accident. On neurologic examination, the left arm was almost plegic. Cervical plain x-rays and computed tomography (CT) scan demonstrated C2 anterior dislocation with left C2-3 locked facet. On magnetic resonance scan, spinal cord was focally contused at dislocation level and the left vertebral artery was totally obstructed. Despite early immobilization and traction with Halo-vest, dislocation at the left C2-3 facet joint could not be reduced, and open reduction had to be performed through posterior approach. The left superior facet of C3 was partially removed and spongious bone fragments taken from C2 laminectomy were placed over decorticated C2-3 facet surfaces. She was followed with Halovest approximately 3 months. At one year follow up, the left upper limb power was normal, and the cervical CT scan showed strong fusion at left C2-3 facet joint. Conclusions: Rapid reduction of cervical dislocation with locked facet(s) is necessary when there is compression to the spinal cord or nerve root.