A hangman’s fracture may have a scary name, but you’re unlikely to suffer this injury, unless you experience a high-energy traumatic event such as a car accident, a fall from height or a serious sports injury. If you do experience one, however, you need to get your neck checked out right away, especially if it hurts.
The hangman’s fracture has a scary name for a good reason: It can become a very serious injury. The name ‘hangman’ is from the fact that this type of broken neck happens in a hanging.
What Is a Hangman’s Fracture?
A hangman’s fracture is a break in a specific part of a particular vertebra. Vertebrae—backbones—are named for the part of the spine they’re in and how far from the top of the spine they are. There are seven bones in the neck, or cervical spine, so they’re named C1 through C7.
A hangman’s fracture is a break in the C2 vertebrae. This bone is called the axis. To be even more specific, a hangman’s fracture is a break in the part of the axis known as the pars interarticularis, which connects the body of the vertebrae and the lamina. This is the back of the bone that protects the spinal cord.
A hangman’s fracture is a hyperextension injury, meaning it happens when the neck snaps back violently. From a medical standpoint, a hangman’s fracture is an interesting injury. Often the spinal cord avoids damage at the time of the injury. However, it is very unstable. A seemingly innocent movement can damage the spinal cord, which can lead to some very serious complications.
Hangman’s Fracture Symptoms
Neck pain is the primary symptom of a hangman’s fracture, but if you’ve sustained one due to an accident or a fall, it could be masked by other pain. Getting in to see a spine specialist is extremely important in those situations, because if you do have a hangman’s fracture, you need to get treated right away.
Because of where the axis vertebra is located, a hangman’s fracture can be extremely dangerous. If the spinal cord is damaged near the axis, it runs the risk of affecting the diaphragm, one of the main muscles used for breathing. If this muscle is paralyzed, you won’t be able to breathe on your own.
Diagnosing a Hangman’s Fracture
An emergency medicine doctor may identify a hangman’s fracture soon after an accident, but you should see an orthopedic spine specialist as soon as you can, even if you’re not diagnosed.
The first step is a physical exam. Your doctor will be checking you for:
- Neck pain
- Bruising around the neck
- Neurologic symptoms like numbness and weakness
- Trouble breathing
Imaging studies are needed to confirm a hangman’s fracture. An X-ray may be able to show the broken neck, but an important function of imaging is to see if there’s a misalignment between the axis and the vertebra under it (the C3 vertebra).
A computed tomography (CT) scan is the best diagnostic method. A CT scan is a composite of multiple X-rays and can show detail that a single X-ray might miss.
Hangman’s Fracture Treatment
It is necessary to immediately stabilize the neck with a hangman’s fracture. Any movement of the neck at this point has the potential to injure the spinal cord and cause serious, permanent complications.
In many cases, surgery won’t be necessary. You may have to wear a neck collar to cut down on movement, both to promote healing and to avoid injury.
More common than a neck brace, however, is halo immobilization. The halo is a type of external fixation device that consists of a ring attached to the head by pins. The ring is supported by poles attached to a vest. Its purpose is to keep the head position stable relative to the rest of the body.
Recovery from a hangman’s fracture may take a long time, but most people do recover fully. One study suggests that 85 percent of people in the study recovered fully after a year.
If you’ve experienced a traumatic injury and have neck or back pain, request an appointment with me or another Summit Medical Group Orthopedics spine specialist. We will diagnose the exact nature of your injury and develop a treatment plan that puts you on the road to recovery.