{
    "abstract": "Hangman's fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman's fractures. The complications and healing rates were analysed according to the fracture type and treatment used.\nAmong patients with hangman's fracture, those with disc damage must be treated surgically.\nA prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (Soci\u00e9t\u00e9Fran\u00e7aisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman's fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely.\nWe included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up.\nHangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation.\nIII.",
    "authors": [
        {
            "affiliation": "ISM, CNRS, unit\u00e9 de chirurgie rachidienne, Aix-Marseille universit\u00e9, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.",
            "firstname": "Sol\u00e8ne",
            "initials": "S",
            "lastname": "Prost"
        },
        {
            "affiliation": "Service de neurochirurgie C et chirurgie du rachis, universit\u00e9 Claude-Bernard Lyon 1, h\u00f4pital P.\u00a0Wertheimer, 59, boulevard Pinel, 69003 Lyon, France.",
            "firstname": "C\u00e9dric",
            "initials": "C",
            "lastname": "Barrey"
        },
        {
            "affiliation": "ISM, CNRS, unit\u00e9 de chirurgie rachidienne, Aix-Marseille universit\u00e9, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France. Electronic address: benjamin.blondel@ap-hm.fr.",
            "firstname": "Benjamin",
            "initials": "B",
            "lastname": "Blondel"
        },
        {
            "affiliation": "ISM, CNRS, unit\u00e9 de chirurgie rachidienne, Aix-Marseille universit\u00e9, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.",
            "firstname": "St\u00e9phane",
            "initials": "S",
            "lastname": "Fuentes"
        },
        {
            "affiliation": "Unit\u00e9 de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, h\u00f4pital Pasteur 2, 30, voie Romaine, 06001 Nice, France.",
            "firstname": "Laurent",
            "initials": "L",
            "lastname": "Barresi"
        },
        {
            "affiliation": "D\u00e9partement de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Gr\u00e9sivaudan, 38700 La Tronche, France.",
            "firstname": "Benjamin",
            "initials": "B",
            "lastname": "Nicot"
        },
        {
            "affiliation": "Unit\u00e9 d'orthop\u00e9die-traumatologie rachis I, CHU de Bordeaux, h\u00f4pital Tripode, place Am\u00e9lie-Raba-L\u00e9on, 33076 Bordeaux cedex, France.",
            "firstname": "Vincent",
            "initials": "V",
            "lastname": "Challier"
        },
        {
            "affiliation": "Service de neurochirurgie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon cedex, France.",
            "firstname": "Maxime",
            "initials": "M",
            "lastname": "Lleu"
        },
        {
            "affiliation": "Service de neurochirurgie, h\u00f4pital Jean-Minjoz, 3, boulevard A.\u00a0Fleming, 25030 Besan\u00e7on cedex, France.",
            "firstname": "Jo\u00ebl",
            "initials": "J",
            "lastname": "Godard"
        },
        {
            "affiliation": "Service d'orthop\u00e9die-traumatologie, CHU de N\u00eemes, avenue du Pr.\u00a0Debr\u00e9, 30000 N\u00eemes, France.",
            "firstname": "Pascal",
            "initials": "P",
            "lastname": "Kouyoumdjian"
        },
        {
            "affiliation": "Service de neurochirurgie, h\u00f4pital Gui de Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France.",
            "firstname": "Nicolas",
            "initials": "N",
            "lastname": "Lonjon"
        },
        {
            "affiliation": "Service de neurochirurgie, CHRU de Lille, h\u00f4pital Roger-Salengro, rue Emile-Laine, 59037 Lille, France.",
            "firstname": "Paulo",
            "initials": "P",
            "lastname": "Marinho"
        },
        {
            "affiliation": "Service de neurochirurgie C et chirurgie du rachis, universit\u00e9 Claude-Bernard Lyon 1, h\u00f4pital P.\u00a0Wertheimer, 59, boulevard Pinel, 69003 Lyon, France.",
            "firstname": "Eurico",
            "initials": "E",
            "lastname": "Freitas"
        },
        {
            "affiliation": "Service de chirurgie du rachis, h\u00f4pitaux universitaires de Strasbourg, 1, place de l'H\u00f4pital, BP 426, 67091 Strasbourg cedex, France.",
            "firstname": "S\u00e9bastien",
            "initials": "S",
            "lastname": "Schuller"
        },
        {
            "affiliation": "Unit\u00e9 de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, h\u00f4pital Pasteur 2, 30, voie Romaine, 06001 Nice, France.",
            "firstname": "J\u00e9r\u00e9my",
            "initials": "J",
            "lastname": "Allia"
        },
        {
            "affiliation": "P\u00f4le IMER, hospices civils de Lyon, 162, avenue Lacassagne, 69424 Lyon cedex 03, France.",
            "firstname": "Julien",
            "initials": "J",
            "lastname": "Berthiller"
        },
        {
            "affiliation": "Service de chirurgie du rachis, h\u00f4pitaux universitaires de Strasbourg, 1, place de l'H\u00f4pital, BP 426, 67091 Strasbourg cedex, France.",
            "firstname": "Yann Philippe",
            "initials": "YP",
            "lastname": "Charles"
        },
        {
            "affiliation": "Soci\u00e9t\u00e9 Fran\u00e7aise de Chirurgie Rachidienne, 56, rue Boisonnade, 75014 Paris, France.",
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": "Hangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation.",
    "copyrights": "Copyright \u00a9 2019 Elsevier Masson SAS. All rights reserved.",
    "doi": "10.1016/j.otsr.2019.03.009",
    "journal": "Orthopaedics & traumatology, surgery & research : OTSR",
    "keywords": [
        "Bone healing",
        "Cervical spine",
        "Fracture union",
        "Hangman's fracture",
        "Surgery"
    ],
    "methods": null,
    "publication_date": "2019-04-22",
    "pubmed_id": "31005699",
    "results": "We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up.",
    "title": "Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients.",
    "xml": "<Element 'PubmedArticle' at 0x788504e9d440>"
}