Atypical hangman’s fracture with concomitant subaxial fracture–dislocation treated with circumferential fusion of C2–C5—a case report

Introduction: Atypical hangman’s fractures are coronally-oriented vertical fractures of the posterior body of C2. Though these are not uncommon injuries, there is a paucity of data investigating the management of these fractures, especially when they occur in association with subaxial fracture dislocations. Case presentation: A 50-year-old male suffered a cervical extension injury when he dove into a shallow swimming pool while intoxicated. Initial examination demonstrated 2/5 strength in the right deltoid and biceps and 3/5 strength in the left deltoid and biceps with no motor or sensory function distal to the C5 level. Cervical CT scan revealed a C2 atypical hangman’s fracture and a C4 right-sided facet fracture with traumatic spondylolisthesis at C4/5. We performed C2–C5 anterior cervical discectomy and fusion followed by a C3–C5 posterior instrumented fusion. At the patient’s two year postoperative visit, the patient has had minimal improvement in neurologic function with 4/5 strength in bilateral deltoids and biceps and 2/5 strength in right wrist extension. Radiographs show a solid arthrodesis on flexion–extension radiographs. Discussion: To our knowledge, this is the first case report discussing the operative management of an atypical hangman’s fracture with a concomitant subaxial fracture–dislocation. This case report adds to our current knowledge by demonstrating a novel anterior–posterior approach for treating these complicated injuries.