Evaluation Of Surgical Treatments And Optimal Treatment For Unstable Hangman’s Fractures

Purposes. The intentions of this study were to evaluate fracture healing followinganterior approach surgery and posterior operation in our hospital and to advise aindication for tansactions of unstable hangman’s fractures.Methods. From2002to2013,22patients with high cervical fractures treated in ourhospital wrere brought into this study, which included type II, IIa, and III Hangman’sfractures according to the Levine-Edwards category. The patient’s sex, age,neurological status, mechanism of injury, and complications were investigated. Theauthor retrospectively analysed the clinical outcome including AIS, NDI, radiologicalexams (angulation, translation, and disc height), and healing situation.Results. The average duration of hospitalization was17.2days. Fusion was got in allcases by13.9±2.2weeks after surgery, as demonstrated on cervical CT scans andX-ray. The average follow-up period was29.4months ranging from11to69months.The average NDI score at the time of this test was6.3±3.1. The mean pretreatmenttranslation was5.3±4.5mm. The initial angulation was5.3°±3.6.3°and thepostoperative angulation was1.1°±1.3°(mean reduction5.7°±3.9°). Thepostoperative and preoperative values for angulation and translation differedmeaningfully (p <0.05). The overall C2-3disc height was5.8±1.3mm preoperatively,whereas3months after surgery it was5.5±1.1mm. These values did not differsignificantly (p=0.092)，and when comparing data of anterior approach, these resultis similar(p=0.097). Because the sample size of combined approach is very small,can’t be analyzed.Conclusions. The author observed available reduction and fracture healing in cases ofunstable hangman’s fractures after surgical therapy, and all patients obtainedsatisfactoy clinical outcomes and neck pain improvement. The author advises thatposterior reduction and screw fixation should be used as a primary management toadvance stability of Hangman’s fracture combining discoligamentous imbalance orcombined fractures, regardless of wich kind of Hangman’s fracture. Anterior approach should be taken only when anterio column sections of discoligament injury, or nerveis oppressed form the front.