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C2 Fracture


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