A hangman’s fracture is a break in one of the vertebrae of the neck. While it can be quite serious, this break can usually be treated successfully.
The vertebrae are the bones that surround the spinal cord from your lower back all the way up to your skull. The hangman’s fracture refers to a break in a bone known as C2, because it is the second bone down from the skull in your cervical (neck) vertebrae.
A fracture can be a partial or complete break in a bone. The injury can also cause the C2 to move out of alignment with the bone right below it, known as the C3.
Neck pain in the area surrounding the injury can be quite intense. However, if you experienced other injuries along with the hangman’s fracture, you may be more aware of your other symptoms. Sometimes people ignore or aren’t aware of neck pain until the shock of the injury wears off.
If the nerves in the spine are affected, you may also experience numbness or tingling in the arms or legs. Damage to nerves that affect your lungs and airways may make it difficult to breathe normally. Stiffness in the neck is also very common. There also may be bruising of the skin near the fracture.
If you experience any of these symptoms after a fall or other injury, see a doctor immediately.
Falls and car accidents are the most common causes of a hangman’s fracture. This type of injury can also be the result of sports activities, such as a forceful hit while playing football or rugby.
A hangman’s fracture affects a part of the vertebrae called the pars interarticularis. This is a part of the bone that connects the main, cylindrical part of the vertebrae, called the body, to the lamina. The laminae are the round parts of the vertebrae that surround the spinal canal.
An injury that causes the neck and head to snap forward and backward, or to twist suddenly, can cause a crack or more serious fracture in the cervical vertebrae.
A hangman’s fracture is often discovered in an emergency room setting. You may be taken there after an accident, fall, or sports injury. In some cases, you may not have other injuries requiring medical attention and may need to wait to be evaluated.
Your doctor will carefully examine your neck, checking for:
- reduced range of motion
- other signs that a bone has been broken or dislodged
Your doctor will order imaging tests to confirm the diagnosis and determine the seriousness of the injury.
X-rays can reveal the extent of the break and any dislocation of the bone. A special type of X-ray, called a computed tomography (CT) scan, can take a series of cross-section images of the neck. These highly detailed images may be necessary to see bone damage that isn’t revealed in a standard X-ray.
An MRI, which uses powerful magnetic fields and radio frequencies to produce pictures for the doctor, can be used by your doctor to see if the injury caused nerve damage. X-rays and CT scans are helpful for seeing a fracture, but not the nerves and other soft tissue.
There are surgical and nonsurgical treatment options for a hangman’s fracture. The severity of the break will dictate what is right for you.
In some cases, surgery won’ t be necessary. A neck brace may be enough to help the fractured bone heal. However, a hangman’s fracture can be a serious injury. The bone doesn’t always heal correctly and achieve stability on its own. Surgery is often required.
If the break is serious, your head and neck may be immobilized. You may have metal pins temporarily placed in the skull and attached to a frame fitted with a pulley, weights, and a rope. This is a form of skeletal traction and is often the initial treatment after such an injury.
If you need surgery, an incision is usually made in the back of the neck. A surgeon will fuse the broken bone together using small rods and screws. Sometimes the incision is made in the front of the neck.
Complicated injuries are occasionally treated with incisions in both the front and the back of the neck. If there are bone fragments pressing against the spinal cord, the surgeon may remove them entirely. This is called surgical decompression.
Successful repair of the broken parts of the bone can lead to excellent recoveries. The long-term prognosis is good. In some cases, the C2 and C3 vertebrae are fused together. In one study, fusion surgery done through the back of the neck proved to be 100 percent successful within six months.
In another study of more than 30 people with a hangman’s fracture, researchers found that among people who experienced the injury, 85 percent of them had a full recovery within a year.
You’ll need to avoid or adjust many activities during your recovery. Early on, you may have difficulty sleeping with your head and neck in traction, or straightened out in a brace. If your doctor determines you would benefit from physical therapy, participate in a program carefully and follow your doctor’s instructions.
While a hangman’s fracture can be severe and may cause major changes in your lifestyle, treatment can go a long way in preserving your health. If you’ve been in a car accident or similar incident, you may feel as though your neck pain or stiffness doesn’t require assistance from a doctor. This isn’t true. Suspicious neck pain, especially after such an incident, should always be evaluated. The sooner you have your injury evaluated and start treatment, the sooner you’ll be feeling better with restored range of motion.