Which fracture is a fracture/dislocation of the atlas and axis caused by extreme hyperextension during abrupt deceleration?

Which fracture is a fracture/dislocation of the atlas and axis caused by extreme hyperextension during abrupt deceleration?

• A. Boxer’s fracture
• B. Colles fracture
• C. Smith fracture
• D. Hangman’s fracture

Answer: (D)

The main idea here is recognizing a high-energy hyperextension injury of the cervical spine that produces a characteristic fracture-dislocation at the axis. Hangman’s fracture refers to a traumatic spondylolysis of the axis (C2) with bilateral pars interarticularis fracture and often anterior subluxation of C2 on C3 after extreme neck extension seen in abrupt deceleration injuries. The mechanism—to hyperextend the neck against an axial load, as in a car crash or a hard fall—causes the pars fractures and forward slip, making this injury unstable and potentially dangerous for the spinal cord. Imaging is most informative with CT to define the pars fractures and the degree of displacement, while management ranges from immobilization (for stability) to surgical stabilization if there is significant instability or ongoing risk to the cord. In contrast, the other injuries listed are in the hand or forearm from local trauma (punching a surface or falling on an outstretched hand) and do not involve the cervical spine.

The main idea here is recognizing a high-energy hyperextension injury of the cervical spine that produces a characteristic fracture-dislocation at the axis. Hangman’s fracture refers to a traumatic spondylolysis of the axis (C2) with bilateral pars interarticularis fracture and often anterior subluxation of C2 on C3 after extreme neck extension seen in abrupt deceleration injuries. The mechanism—to hyperextend the neck against an axial load, as in a car crash or a hard fall—causes the pars fractures and forward slip, making this injury unstable and potentially dangerous for the spinal cord. Imaging is most informative with CT to define the pars fractures and the degree of displacement, while management ranges from immobilization (for stability) to surgical stabilization if there is significant instability or ongoing risk to the cord. In contrast, the other injuries listed are in the hand or forearm from local trauma (punching a surface or falling on an outstretched hand) and do not involve the cervical spine.