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C2 Fracture
synonyms: Hangman's fracture, C2 traumatic spondylolisthesis
C2 Fracture ICD-9
C2 Fracture Etiology / Epidemiology / Natural History
- High energy trauma
- Hangman's Fracture = bilateral C2 pars interarticularis fracture
C2 Fracture Anatomy
C2 Fracture Clinical Evaluation
- Palpate entire spine for tenderness / step off.
- Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
- Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
- See ASIA form.
C2 Fracture Xray / Diagnositc Tests
- A/P, Lateral, Odontoid: .
- CT cervical spine:
- MRI: i
C2 Fracture Classification / Treatment
- Type I: < 3mm of C2-3 subluxation
-Treatment = orthosis x 6-12 weeks
- Type II: >3mm of C2-3 subluxation with minimal angulation
-Treatment: halo x 12 weeks
- Type IIa: kyphotic angulation and disk space narrowing without signiciation subluxation
-Treatment: reduced with gentle extension and compression followed halo x 12 weeks.
- Type III: ALL, PLL and facet joints disrupted
-Treatment = posterior open reduction and C2-3 fusion.
- C2 Avulsion (extension teardrop) Fracture
-avulsion of small portion of anterior-inferior vertebral body
-Treatment = hard collar
- Odontoid fracture
C2 Fracture Associated Injuries / Differential Diagnosis
- Head injury
- Skull base fracutres
- Lower cranial nerve palsies (CN12)
- Upper cervical spine injuries
C2 Fracture Complications
C2 Fracture Follow-up Care
C2 Fracture Review References
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