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2017 ; 96
(28
): e7492
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A novel classification for atypical Hangman fractures and its application: A
retrospective observational study
#MMPMID28700494
Li G
; Zhong D
; Wang Q
Medicine (Baltimore)
2017[Jul]; 96
(28
): e7492
PMID28700494
show ga
Atypical Hangman fractures (AHF) were first formally reported and considered to
be more often associated with neurologic deficit in 1993. However, there is a
paucity of literature focusing on these fractures. The purpose of the
retrospective study was to introduce a new classification scheme for AHF and its
application.Sixty-two patients with Hangman fractures were identified. There were
46 (74.2%, 46/62) AHF patients, including 29 type I, 9 type II, 5 type IIa, and 3
type III fractures (Levine-Edwards classification). Based on fracture patterns,
incidence, and their impact on neurologic status, a primary classification for
AHF was devised. The clinical features of AHF were observed, and a new
classification was introduced. The appropriate treatment strategy of AHF was
discussed.Of 46 AHF patients, 27 underwent surgical treatment (24 with posterior
approach with screw-rod fixation and fusion, 1 with anterior approach by C2/3
discectomy and fusion, and 2 with anterior and posterior approach), and the
remaining 19 patients underwent nonoperative treatment. No patient complained
severe neck pain at final follow-up. Neurologic status improved 1 to 2 grade in
12 cases with neurologic deficit. All patients achieved bony fusion within the
follow-up period.AHF should be recognized as a distinct fracture subtype. The new
classification for AHF is based on the feature of fracture patterns, injury
mechanism, incidence, and their impact on neurologic deficit. And the new
classification is complementary to Levine-Edwards.