Combined Anterior-Posterior Fixation and Fusion for Completely Dislocated Hangman's Fracture: A Retrospective Analysis of 11 Cases.

STUDY DESIGN: Retrospective clinical study.

PURPOSE: To evaluate the effectiveness and feasibility of combined anterior-posterior fixation and fusion for the treatment of completely dislocated hangman's fracture.

SUMMARY OF BACKGROUND DATA: A completely dislocated hangman's fracture describes the complete anterior displacement of the C2 vertebral body onto the C3 body. This type of fracture is exceptionally unstable, and for which the management is challenging. Specific treatment strategies need to be further clarified.

METHODS: From January 2003 to January 2012, 11 patients with completely dislocated hangman's fracture underwent combined anterior-posterior fixation and fusion at our institution; an anterior-posterior approach was used in 9 patients, and an anterior-posterior-anterior approach was used in 2 patients. The operative time, hospital duration, neurological improvement, fusion rate, and complications were assessed.

RESULTS: The operation times of the 2 anterior-posterior-anterior surgeries (165 and 210 min) were longer than the anterior-posterior approach surgeries (mean, 133 min; range: 110-155 min). The average hospital duration was 8.5 days (range: 7.0-13.0 d). Postoperative reduction and solid fusion were achieved in all patients. Neurological status was significantly improved, as the mean Japanese Orthopedic Association (JOA) score significantly increased from a preoperative score of 8.9±1.7 to 14.6±1.6 at the final follow-up (P<0.01). The mean neurological recovery rate was 51%. Moderate postoperative neck pain occurred in 2 patients, which was relieved after 2 months of conservative treatment with oral celecoxib. The mean visual analog scale pain score was 1.4±0.8 at the last assessment. Hoarseness was found after surgery in 1 patient who recovered 1 month later without any treatment. No graft-related or plate-related complications occurred during the entire follow-up period.

CONCLUSIONS: Combined anterior-posterior fixation and fusion is an effective and safe treatment for completely dislocated hangman's fracture.