Abstract
Introduction
Hangman fracture is the second most frequent axis fracture, alter odontoid fracture. The most widely used classification is that of Levine and Edwards, based on lateral X-ray. Type I are those fractures with < 3 mm displacement. Type II fractures are those with > 3 mm displacement. Type IIa show little or no displacement, but a severe angle. Type III fractures are those with severe displacement, angle, and unifacet or bifacet dislocation. In several cases, Hangman fracture is associated with other lesions which require priority attention.
Patient and Methods: We present the case of a 46-year-old female patient who suffered from polytrauma because of a car accident. She was driving using her seatbelt, but no airbag was available in the car. On entry to the hospital, she presented Glasgow 15/15, Asia E, diabetes antecedents, HTA, and BMI 69.4 kg/m . Also, femur and right ankle fracture plus C2 traumatic spondylolisthesis type IIa. Neurological tests were normal. There was acute cervical and right lower limb pain. Initially, “damage control” was performed: stabilization of extraspinal lesions with external tutor in femur and ankle osteodesis. Since the patient presented morbid obesity, and due to the need of stabilizing her CD fracture, closed reduction and percutaneous osteosynthesis with bilateral fluoroscopically guided pedicle screw. It is absolutely necessary to have a clear front and lateral visualization of the cervical spine to plan the screw trajectory and the incision.
Results
A correct closed reduction of the fracture was attained. We projected each screw trajectory through radioscopy. An incision was done at C6 level and minimally invasive surgery was practiced, using two bilateral cannulated pedicle screws with correct fracture compression. Postoperatory X-ray and TAC showed correct position of both screws and fracture reduction. The patient had a satisfactory global evolution, with total relief of cervical pain, withdrawal of cervical orthosis, and precocious movement. In X-ray controls at 30, 60, and 90 days, correct fracture reduction was observed. TAC performed 6 months after the accident showed fracture consolidation.
Conclusion
We consider that, in certain selected cases, fluoroscopically guided percutaneous surgery is a good alternative when trying to give patients the best solution available. In our case, the patient received its benefits since she continued her orthopedical rehabilitation of other associated lesions without any inconvenience for the cervical surgery, with great pain relief, avoiding deep approach through the body midline; receiving minimal scars and with correct fracture reduction and consolidation. Patient selection is relevant to such an intervention. The learning curve is slow, so one must be used to the conventional technique to then do percutaneous technique.