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Posterior fixation for paediatric and adolescent unstable hangman’s fracture: evolution to C1 sparing techniques

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Abstract

Purpose

The aim was to study surgical outcomes in hangman’s fractures in paediatric and adolescent patients and to demonstrate evolution in posterior surgery from C1-C2-C3 fusion to C1 sparing techniques.

Methods

Patients (aged ≤ 18 years) operated at a tertiary level centre between September 2011 to February 2018 with more than 1 year of follow-up were included. Neurological status, type of fracture, operating time, blood loss, follow-up, and complications were assessed.

Results

Nine patients were included, with mean age mean of 16.45 years, with a mean follow-up of 42.78 months. Six patients having neurological deficit showed improvement. Two patients, one having undergone C1-C3 lateral mass screw rod fixation (LMSF) and other had C2 pedicle screw with C3 LMSF, developed kyphosis for which fixation was further extended caudally. One patient with an old hangman’s fracture with reabsorbed axis pedicle underwent C2 body screw along with C3-C4 pedicle screw rod fixation and C2 pedicle reconstruction. All patients showed evidence of postoperative fusion.

Conclusion

Hangman’s fractures in young patients can be successfully managed via posterior fixation. In our centre, we have evolved in the direction of motion preservation at C1 C2 joint, along with 3 column stable fixation of the C2 pedicle. C2 pedicle reformation has allowed motion preserving surgery in complex fracture types. Extension of construct till C4 in selected cases is important to prevent postoperative kyphosis.

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Abbreviations

ASIA:

American Spine Injury Association

LMSF:

Lateral mass screw rod fixation

PSRF:

Pedicle screw rod fixation

CT:

Computed Tomography

MRC:

Medical Research Council

CTA:

Computed tomographic angiography

MRI:

Magnetic resonance imaging

RTA:

Road traffic accident

VA:

Vertebral artery

AP:

Antero posterior

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Author information

Author notes

  1. Mohit Agrawal and Dattaraj Sawarkar contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India

    Mohit Agrawal

  2. Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Room No. 717, New Delhi, 110029, India

    Dattaraj Sawarkar, Pankaj Kumar Singh, Shashwat Mishra, Rajesh Meena, Deepak K Gupta, P. Sarat Chandra & Shashank S Kale

Authors
  1. Mohit Agrawal
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  2. Dattaraj Sawarkar
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  3. Pankaj Kumar Singh
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  4. Shashwat Mishra
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  5. Rajesh Meena
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  6. Deepak K Gupta
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  7. P. Sarat Chandra
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  8. Shashank S Kale
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Contributions

Mohit Agrawal, MCh; Dattaraj Sawarkar, MCh; Pankaj Kumar Singh, MCh: the conception and design of the study, or acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version to be submitted.

Shashwat Mishra, MCh; Rajesh Meena, MCh; Deepak K Gupta, MCh; P. Sarat Chandra, MCh; Shashank S Kale, MCh: drafting the article or revising it critically for important intellectual content and final approval of the version to be submitted.

Corresponding author

Correspondence to Pankaj Kumar Singh.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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Agrawal, M., Sawarkar, D., Singh, P.K. et al. Posterior fixation for paediatric and adolescent unstable hangman’s fracture: evolution to C1 sparing techniques. Childs Nerv Syst 37, 2319–2327 (2021). https://doi.org/10.1007/s00381-021-05140-9

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  • DOI: https://doi.org/10.1007/s00381-021-05140-9

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