Fractura del verdugo

A hangman’s fracture is a break through a key part of the second neck bone (C2) on both sides, often with some slipping of C2 on the bone below (C3). It usually happens after a strong backward snapping of the head, such as in a car crash or fall.​

1) What is this condition?

  • The fracture goes through a thin bridge of bone (pars) on each side of C2, sometimes allowing the front of C2 to slide forward on C3.​

  • Symptoms often include neck pain after trauma; other injuries may distract from the neck injury, so scans are critical.​

2) How serious is it?

  • Many hangman’s fractures do not initially damage the spinal cord because the canal briefly opens up at the moment of injury.​

  • The injury can still be highly unstable; without proper treatment, shifting bones can later injure the spinal cord, causing weakness, paralysis, or worse.​

3) Non‑surgical treatments

  • Rigid cervical collar for several weeks to months for stable, low‑grade fractures (little slipping or angulation).​

  • Halo vest (a ring fixed to the skull with pins, connected to a vest) for stronger immobilization in more unstable but still treatable fractures.​

  • Pain control, careful positioning, and treatment of bone thinning or other risk factors as needed.​

4) Possible surgery

  • Posterior C2–C3 fixation: screws and rods placed from the back to lock C2 and C3 together.​

  • Posterior C1–C3 fusion in some cases, which includes one more level above for added stability.​

  • Less commonly, an anterior C2–C3 fusion (from the front) if the main problem is disc and front‑side instability.​

5) Goals: surgery vs non‑surgical care

  • Non‑surgical goals:

    • Allow the fracture to heal in good alignment using external support, avoiding surgical risks in patients whose fractures are stable enough.​

  • Surgery goals:

    • Securely stabilize unstable fractures, correct any slip or angulation, relieve neck pain, and prevent late spinal cord injury or non‑healing.​

6) How surgery can fix the problem

  • Posterior fixation uses screws placed into C2 and C3 (and sometimes C1) connected by rods to hold the bones in correct position.​

  • Bone graft is added so C2 and C3 fuse into a solid unit over time, removing motion at the injured segment and allowing reliable healing.​

7) Risks of surgery (general and specific)

  • General: infection, bleeding, blood clots, lung or heart complications, and anesthesia risks—higher in older or medically fragile patients.​

  • Neck‑specific:

    • Injury to the spinal cord, nerves, or nearby arteries, leading to weakness, numbness, stroke‑like symptoms, or paralysis.​

    • Hardware failure or failure of fusion, sometimes requiring revision surgery.​

8) Chances this surgery will work

  • Posterior C2–C3 or C1–C3 fixation generally achieves high fusion rates and good pain relief in most series.​

  • A systematic review suggests surgical stabilization is effective for unstable hangman’s fractures, with good alignment and low major complication rates when properly indicated.​

9) Possible complications from surgery

  • Short‑term: wound infection, hardware malposition, need for screw repositioning, or spinal fluid leak.​

  • Long‑term: neck stiffness and reduced rotation (more pronounced with C1–C3 fusion), chronic axial neck pain, or adjacent‑level degeneration.​

10) Typical recovery from the condition

  • Most low‑grade hangman’s fractures heal well with external immobilization alone; non‑operative treatment fails in about 5% overall but up to 50% in the most unstable types.​

  • Even without surgery, prolonged halo use can cause complications such as pin infections, breathing problems, and balance/fall risk, especially in older adults.​

11) Typical recovery after surgery

  • Hospital stay focuses on pain control, neck immobilization (often with a temporary collar), and early mobilization.​

  • Neck motion is restricted at first, with gradual increase as fusion progresses over several months; some permanent loss of rotation is expected.​

  • Most patients move from hospital to home or short rehab and improve in neck pain and stability over weeks to months.​

12) How long in the hospital

  • Uncomplicated posterior fixation typically requires about 3–5 days in hospital.​

  • Longer stays may be needed for multi‑trauma, older age, or medical/surgical complications.​

13) Long‑term outlook

  • With timely and appropriate treatment, many patients achieve solid fusion and good neck pain control, with low rates of late neurologic problems.​

  • C2–C3 fixation tends to preserve more upper‑neck motion and cause less long‑term neck disability than longer C1–C3 constructs when it is anatomically feasible.​

  • Untreated or poorly healed fractures can leave significant instability and risk of delayed spinal cord injury.​

14) Need for outpatient follow‑up

  • Regular follow‑up with spine or neurosurgery for clinical checks and imaging (X‑rays/CT) to confirm alignment and healing.​

  • Ongoing brace or collar adjustments and eventual weaning once stability and fusion are documented.​

  • Long‑term monitoring for adjacent‑level problems, chronic neck pain, and, if present, management of any associated spinal cord or nerve issues.