CT-guided internal fixation of a hangman's fracture

Most hangman's fractures are treated conservatively. If surgery is indicate d, an anterior approach using a C2/C3 graft and plate fusion is usually pre ferred. Another surgical method according to Judet is direct transpedicular osteosynthesis by the dorsal approach. This surgery is frequently rejected because of the high risk of spinal cord damage or vertebral artery tear. D irect transpedicular osteosynthesis of hangman's fracture according to Jude t is a "physiological operation" that does not cause fusion and creates ana tomical conditions. This procedure enables appropriate reduction, compressi on of fragments and immediate stabilization of the C2 segment. A new aspect of Judet's method of internal fixation of a hangman's fracture is now prop osed. Computed tomographic (CT) guidance is used to ensure safe and exact i ntroduction of two screws from the posterior approach. This method of CT-gu ided internal fixation of hangman's fracture allows, preoperatively, for an accurate assessment of the pattern and course of fracture line, selection of the anatomically safest screw path and determination of an appropriate s crew length. The procedure also allows for accurate intraoperative control of instrument and implant placement, screw tightening, fracture reduction a nd anchoring of the screw tip in the contralateral cortex, using repeated C T scans. The procedure is performed in a CT unit under sterile conditions. This method was used in the treatment of eight male and two female patients aged 21-71 years. All treated patients were without neurological deficit. Follow-up ranged from 12 to 57 months (mean 33.3 months). No intraoperative or early or late postoperative complications were apparent. This new aspec t of the surgical procedure ensures highly accurate screw placement and min imal risks, and fully achieves the "physiological" internal fixation.