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Hangman’s fracture: a clinical review based on surgical treatment of 15 cases

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Abstract

This is a retrospective analysis of cases with hangman’s fracture. The subject of ‘hangman’s fracture’ has been elaborately evaluated in the literature. The authors propose an alternative format of surgical treatment that is based on modification of existing classification schemes. During the period 2015 to March 2020, 15 patients having hangman’s fracture were identified and were surgically treated. The clinical condition was classified on the basis of American Spinal Injury Association scale (ASIA scale) and VAS parameters. The patients were classified into 4 groups depending on the presence (or absence) of atlantoaxial and/or C2–3 instability. Surgical decisions were guided by the proposed classification. Clinical evaluation and dynamic CT scan were done at follow-up visits. During the average follow-up of 26 months, all patients are essentially asymptomatic. There was marginal restriction of extent of neck movements in all cases. There was solid bone fusion in all cases. The proposed novel classification scheme based on the presence of atlantoaxial and C2–3 instability assisted in directing the treatment strategy of hangman’s fracture.

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Authors and Affiliations

  1. Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India

    Atul Goel, Akshay Hawaldar, Abhidha Shah, Sagar Bhambere, Aditya Lunawat, Malwinder Singh, Mehul Baldha & Nishchith Sudarshan

  2. Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India

    Atul Goel

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  1. Atul Goel
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  2. Akshay Hawaldar
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  3. Abhidha Shah
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  4. Sagar Bhambere
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  5. Aditya Lunawat
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  6. Malwinder Singh
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  7. Mehul Baldha
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  8. Nishchith Sudarshan
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Contributions

Atul Goel: conceptualisation, methodology, validation, formal analysis, writing – original draft, writing – review and editing, supervision, project administration.

Akshay Hawaldar: methodology, data collection, writing – review and editing.

Abhidha Shah: conceptualisation, methodology, validation, formal analysis, writing – original draft, writing – review and editing.

Sagar Bhambere: methodology, data collection, writing – review and editing.

Malwinder Singh: methodology, data collection, writing – review and editing.

Aditya Lunawat: methodology, data collection, writing – review and editing.

Mehul Baldha: methodology, data collection, writing – review and editing.

Nishchith Sudarshan: methodology, data collection, writing – review and editing.

Corresponding author

Correspondence to Atul Goel.

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Ethics approval

Retrospective data collection was approved by the local ethics committee. Due consent of the patients was taken to include their data in the analysis. All the patients provided written informed consent before surgery, and all clinical tests and surgical procedures were conducted according to principles of Declaration of Helsinki.

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The authors declare no competing interests

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Goel, A., Hawaldar, A., Shah, A. et al. Hangman’s fracture: a clinical review based on surgical treatment of 15 cases. Neurosurg Rev 45, 595–606 (2022). https://doi.org/10.1007/s10143-021-01556-8

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  • DOI: https://doi.org/10.1007/s10143-021-01556-8

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