Introduction: Traumatic Spondylolisthesis of Axis (ATS) was first described in 18661 for bilateral pars fracture of C2 and was termed “Hangman’s fracture” nearly a century later in 19652. The fracture which was described in cases of judicial hangings by Woods- Jones3 (1913), was also observed following vehicular accidents4. One factor that can irrefutably be attributed to this fracture is change or evolution not only in what was described in fatality is now seen and managed for deformity with minimal or no neurological deficits with numerous management strategies.

Methods: A group of 10 surgical patients were all diagnosed with radiograph, magnetic resonance imaging (MRI), and CT scans. Initial and final radiographs were measured for anterior translation and angulations of the C2 over C3 . Initial attempts of application of external skull traction as used in all these patients to reduce the fracture. Then an anterior C2-C4 fusion and locking plate fixation was performed. Here the technique lies in the sensible use of C4 as an anchor to elevate the C3 body which is posterior dislocated. About 10 patients underwent these anterior surgeries only and all were achieved satisfactory reduction and fusion.

Results: The follow-up ranged from 06 to 54 months, with an average 39.6 months. There was radiographic evidence of continuity of the fracture at C2 pars was seen in all the patients at the end of 6 months on an average. Neck pain was resolved in nearly all patients after surgery. No hardware failures or infections were observed.

Conclusions: We believe that there is no need single stage 360° fusion nor C3corpectomy for Type III hangman's fractures. For hangman's fractures with significant deformity and gapping, in our experience that immediate single-stage anterior surgery reduction, instrumentation, and arthrodesis was achieved. Superior maintenance of lordotic curvature and excellent clinical outcome.

Patient Care: IT AVOIDS THE UNNECESSARY GLOBAL FUSIONS IN UNSTABLE HANGMAN FRACTURES AND MINIMISES RISK TO THE PATIENTS

Learning Objectives: . To determine the clinical effectiveness of sole anterior C2-C4 reduction and fusion for the management of unstable type III hangman's fractures

References: 1. Haughton S. on hanging, considered from a mechanical and physiological point of view. Philosl Mag J Sci 1866;32:23-34. 2. Schneider RC, Livingston KE, Cave AJE. “Hangman’s frature” of the cervical spine. J Neurosurg . 1965;22:141-154. 3. Wood-Jones F. The ideal lesion produced by judicial hanging. Lancet1913;1:53-54. 4. Josten C. Die traumatische Spondylolisthese des Axis. Orthopade 1999;28(5):394–400. 5. Niijima K,Huang JC. Hangman’s fracture vs Hanged man’s fracture vs hangee’s fracture. Acta Neurochirurgica. 2013; May55(5): 1891. 6. Wang C, Ma H, Yuan W, Wang X, Chen H, Wu X. Anterior C3 corpectomy and fusion for complex Hangman's fractures. Int Orthop. 2013 Jan;37(1):89-93. 7. Coric D, Wilson JA, Kelly DL Jr.Treatment of traumatic spondylolisthesisof the axis with nonrigid immobilization: a review of 64 cases. J Neurosurg 1996;85:550-554. 8. Li X-F, Dai L-Y, Lu H, Chen X-D. A systematic review of the management of hangman’s fractures. Eur Spine J 2006;15(3):257–269. 9. White A, Panjabi M: 32. Clinical Biomechanics of the Spine. Philadelphia, JB Lippincott, 1990, ed 2, pp 169-275. 10. Vieweg U, Schultheiss R (2001) A review of halo vest treatment of upper cervical spine injuries. Arch Orthop Trauma Surg 121:50–55. 11. Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA (1981) Fractures of the ring of the axis: a classification based on the analysis of 131 cases. J Bone Joint Surg Br 63:319–327. 12. Hadley, Browner, Sonntag: Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery 17:281-290, 1985. 13. Vaccaro, Madigan, Bauerle, Blescia, Cotler: Early halo immobilization of displaced traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976) 27:2229-2233, 2002. 14. Yi Yang , Mengying Yang , Shan Wu , Ying Hong , Litai Ma , Beiyu Wang. et al., Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province,April 30 2016. 15. Francis WR, Fielding JW, Hawkins RJ, Pepin J, Hensinger R: Traumatic spondylolisthesis of the axis, J Bone Joint Surg [Br] 63-B:313-318, 1981. 16. Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 1985;67(2):217–226. 17. Leconte P. Fracture et luxation des deux premieres vertebres cervicales. In: Judet R, ed. Luxation Congenitale De La Hanche. Fractures Du Cou-De-Pied Rachis Cervical. Actualites De Chirurgie. Orthopedique De l’Hopital Raymond-Poincare. Vol. 3. Paris, France: Masson et Cie; 1964:147–166. 18. Ding T, Maltenfort M, Yang H, et al. Correlation of C2 fractures and vertebral artery injury. Spine (Phila Pa 1976) 2010;35(12):E520–E524. 19. Wang J1, Chen H, Cao P, Yuan W, Wu X, Liu G, Li R, Zang F, Shi L, Wang A. Combined Anterior-Posterior Fixation and Fusion for Completely Dislocated Hangman’s Fracture A Retrospective Analysis of 11 Cases. Clin Spine Surg. 2017 Oct;30(8):E1050-E1054 20. Xie N, Khoo LT, Yuan W, et al. Combined anterior C2-C3 fusion and C2 pedicle screw fixation for the treatment of unstable hangman’s fracture: a contrast to anterior approach only. Spine2010;35:613–619. 21. José L Romeo B, Benedicto O C, Carlos G, Koji T, Marcius Bo Marques dos Santos1. SURGICAL MANAGEMENT OF AXIS’ TRAUMATIC SPONDYLOLISTHESIS Hangman’s fracture .Arq Neuropsiquiatr 2004;62(3-B):821-826 1. Haughton S. on hanging, considered from a mechanical and physiological point of view. Philosl Mag J Sci 1866;32:23-34. 2. Schneider RC, Livingston KE, Cave AJE. “Hangman’s frature” of the cervical spine. J Neurosurg . 1965;22:141-154. 3. Wood-Jones F. The ideal lesion produced by judicial hanging. Lancet1913;1:53-54. 4. Josten C. Die traumatische Spondylolisthese des Axis. Orthopade 1999;28(5):394–400. 5. Niijima K,Huang JC. Hangman’s fracture vs Hanged man’s fracture vs hangee’s fracture. Acta Neurochirurgica. 2013; May55(5): 1891. 6. Wang C, Ma H, Yuan W, Wang X, Chen H, Wu X. Anterior C3 corpectomy and fusion for complex Hangman's fractures. Int Orthop. 2013 Jan;37(1):89-93. 7. Coric D, Wilson JA, Kelly DL Jr.Treatment of traumatic spondylolisthesisof the axis with nonrigid immobilization: a review of 64 cases. J Neurosurg 1996;85:550-554. 8. Li X-F, Dai L-Y, Lu H, Chen X-D. A systematic review of the management of hangman’s fractures. Eur Spine J 2006;15(3):257–269. 9. White A, Panjabi M: 32. Clinical Biomechanics of the Spine. Philadelphia, JB Lippincott, 1990, ed 2, pp 169-275. 10. Vieweg U, Schultheiss R (2001) A review of halo vest treatment of upper cervical spine injuries. Arch Orthop Trauma Surg 121:50–55. 11. Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA (1981) Fractures of the ring of the axis: a classification based on the analysis of 131 cases. J Bone Joint Surg Br 63:319–327. 12. Hadley, Browner, Sonntag: Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery 17:281-290, 1985. 13. Vaccaro, Madigan, Bauerle, Blescia, Cotler: Early halo immobilization of displaced traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976) 27:2229-2233, 2002. 14. Yi Yang , Mengying Yang , Shan Wu , Ying Hong , Litai Ma , Beiyu Wang. et al., Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province,April 30 2016. 15. Francis WR, Fielding JW, Hawkins RJ, Pepin J, Hensinger R: Traumatic spondylolisthesis of the axis, J Bone Joint Surg [Br] 63-B:313-318, 1981. 16. Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 1985;67(2):217–226. 17. Leconte P. Fracture et luxation des deux premieres vertebres cervicales. In: Judet R, ed. Luxation Congenitale De La Hanche. Fractures Du Cou-De-Pied Rachis Cervical. Actualites De Chirurgie. Orthopedique De l’Hopital Raymond-Poincare. Vol. 3. Paris, France: Masson et Cie; 1964:147–166. 18. Ding T, Maltenfort M, Yang H, et al. Correlation of C2 fractures and vertebral artery injury. Spine (Phila Pa 1976) 2010;35(12):E520–E524. 19. Wang J1, Chen H, Cao P, Yuan W, Wu X, Liu G, Li R, Zang F, Shi L, Wang A. Combined Anterior-Posterior Fixation and Fusion for Completely Dislocated Hangman’s Fracture A Retrospective Analysis of 11 Cases. Clin Spine Surg. 2017 Oct;30(8):E1050-E1054 20. Xie N, Khoo LT, Yuan W, et al. Combined anterior C2-C3 fusion and C2 pedicle screw fixation for the treatment of unstable hangman’s fracture: a contrast to anterior approach only. Spine2010;35:613–619. 21. José L Romeo B, Benedicto O C, Carlos G, Koji T, Marcius Bo Marques dos Santos1. SURGICAL MANAGEMENT OF AXIS’ TRAUMATIC SPONDYLOLISTHESIS Hangman’s fracture .Arq Neuropsiquiatr 2004;62(3-B):821-826