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

• See Spine 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