Hangman Fracture Types

Traumatic spondylolisthesis of C2 (hangman fracture) involve bilateral pedicle fractures and can be classified based on the degree of displacement of C2 and C3 on lateral cervical spine radiographs.

• Type I (hyperextension with axial loading): < 3 mm of anterior C2 displacement and minimal angulation (< 3 degrees). Anterior and posterior longitudinal ligaments and C2-C3 disk are intact; therefore, considered stable.
• Type II (hyperextension with axial loading followed by flexion and axial compression): > 3mm displacement and > 3 degrees of angulation. Mild disruption of the anterior longitudinal ligament and significant disruption of the posterior longitudinal ligament and C2-C3 disk; therefore, considered unstable.
• Type IIA (flexion with concomitant distraction): No anterior displacement, but severe angulation. C2-C3 disk disruption and some injury to posterior longitudinal ligament; therefore, considered unstable.
• Type III (flexion with concomitant axial compression): Severe displacement and severe angulation. C2-C3 disk disruption, unilateral or bilateral C2-C3 facet dislocations and varying degrees of injury to the anterior and posterior longitudinal ligaments. Considered unstable.