Motion-Preserving Bilateral Isthmus Screw Fixation for Unstable Hangman's Fracture: A Case Report.
- 1Department for Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland.
Abstract
Hangman's fractures account for 4-7% of cervical spine fractures. Unstable fractures require surgical treatment, yet traditional fusion techniques sacrifice upper cervical motion. Direct isthmus screw fixation, first described in 1970, offers anatomic reduction with motion preservation but remains underutilized. We report bilateral dorsal isthmus screw fixation for an unstable Type IIa Hangman's fracture with functional follow-up at 13 months. A 26-year-old male sustained a Type IIa Hangman's fracture according to the Levine-Edwards classification with 12.4° kyphotic angulation and approximately 3 mm ventral translation following a 3-m fall. He had no neurological deficit. Combined closed and Penfield dissector-assisted open reduction followed by bilateral dorsal isthmus screw fixation was performed under biplanar fluoroscopic guidance. Stable fracture reduction and radiographic bony union were achieved without neurological or vascular complications. At 1 year, the patient was asymptomatic, had returned to full-time work, and participated in sports without restrictions. Radiographs showed progressive C2/3 degenerative changes with osteophyte formation. Functional flexion-extension radiographs at 13 months confirmed preserved segmental mobility at C2/3 without pathological instability. Bilateral dorsal isthmus screw fixation achieved radiographic union, excellent clinical recovery, and preserved C2/3 motion at 13 months in this young patient with an unstable Type IIa Hangman's fracture. Progressive C2/3 degeneration despite preserved mobility suggests that longer-term follow-up is required in similar cases.
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BibTeX
@article{lupi2026motionpreserving,
title = {{Motion-Preserving Bilateral Isthmus Screw Fixation for Unstable Hangman's Fracture: A Case Report.}},
author = {Valérie Laura Lupi and Christian Tinner and Moritz C Deml and Sonja Häckel},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8440},
url = {https://europepmc.org/article/MED/42997098},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Motion-Preserving Bilateral Isthmus Screw Fixation for Unstable Hangman's Fracture: A Case Report.
AU - Valérie Laura Lupi
AU - Christian Tinner
AU - Moritz C Deml
AU - Sonja Häckel
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8440
UR - https://europepmc.org/article/MED/42997098
AB - Hangman's fractures account for 4-7% of cervical spine fractures. Unstable fractures require surgical treatment, yet traditional fusion techniques sacrifice upper cervical motion. Direct isthmus screw fixation, first described in 1970, offers anatomic reduction with motion preservation but remains underutilized. We report bilateral dorsal isthmus screw fixation for an unstable Type IIa Hangman's fracture with functional follow-up at 13 months. A 26-year-old male sustained a Type IIa Hangman's fracture according to the Levine-Edwards classification with 12.4° kyphotic angulation and approximately 3 mm ventral translation following a 3-m fall. He had no neurological deficit. Combined closed and Penfield dissector-assisted open reduction followed by bilateral dorsal isthmus screw fixation was performed under biplanar fluoroscopic guidance. Stable fracture reduction and radiographic bony union were achieved without neurological or vascular complications. At 1 year, the patient was asymptomatic, had returned to full-time work, and participated in sports without restrictions. Radiographs showed progressive C2/3 degenerative changes with osteophyte formation. Functional flexion-extension radiographs at 13 months confirmed preserved segmental mobility at C2/3 without pathological instability. Bilateral dorsal isthmus screw fixation achieved radiographic union, excellent clinical recovery, and preserved C2/3 motion at 13 months in this young patient with an unstable Type IIa Hangman's fracture. Progressive C2/3 degeneration despite preserved mobility suggests that longer-term follow-up is required in similar cases.
SN - 2250-0685
SN - 2321-3817
ER -