Abstract
Introduction: Stable hangman's fractures are usually treated with a Halo vest fixation; however,
this is not always effective in patients with polytrauma. These patients benefit from
minimally invasive surgery because it allows for early rehabilitation and reduced
nursing care. This is the case report on percutaneous screw fixation using three dimensional
fluoroscopy-assisted navigation in a patient with polytrauma and a hangman's fracture.
Case Report: The patient was a 69-year-old woman involved in a traffic accident. Radiographs and
CT showed bilateral fractures through the neural arch at the base of the C2 pedicles.
External immobilzation was difficult due to her polytrauma.
Intervention: A dynamic reference arc was attached to the spinous process of the axis through a
small incision. After image acquisition, the fluoroscope workstation generated 3-dimensional
reconstructions of the imaged anatomy. We made two small, lateral incisions for percutaneous
screw insertion, and used an image-guided awl to create screw holes. A guide-wire
was inserted through this screw pilot hole, and a cancellous lag screw was inserted
over the guide-wire. At her final follow-up, the patient had no neurological deficits
and bony union was achieved.
Conclusion: Percutaneous screws fixation using three-dimensional fluoroscopy proved to be a useful
technique for the treatment of hangman's fracture.
Key words
minimally invasive surgery - three-dimensional fluoroscopy - hangman's fracture -
percutaneous fixation - Iso-C3D - navigation
References
- 1
Müller EJ, Wick M, Muhr G.
Traumatic spondylolisthesis of the axis: treatment rationale based on the stability
of the different fracture types.
Eur Spine J.
2000;
9
123-128
- 2
Duggal N, Chamberlain RH, Perez-Garza LE. et al .
Hangman's fracture: a biomechanical comparison of stabilization techniques.
Spine.
2007;
32
182-187
- 3
Taller S, Suchomel P, Lukás R. et al .
CT-guided internal fixation of a hangman's fracture.
Eur Spine J.
2000;
9
393-397
- 4
Blondel B, Metellus P, Fuentes S. et al .
Single anterior procedure for stabilization of a three-part fracture of the axis (odontoid
dens and hangman fracture): case report.
Spine.
2009;
34
E255-E257
, 2009
- 5
Ying Z, Wen Y, Xinwei W. et al .
Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of
the axis.
Spine.
2008;
33
255-258
- 6
Rajasekaran S, Vidyadhara S, Shetty AP.
Iso-C3D fluoroscopy-based navigation in direct pedicle screw fixation of hangman fracture:
a case report.
J Spinal Disord Tech.
2007;
20
616-619
- 7
Effendi B, Roy D, Cornish B. et al .
Fractures of the ring of the axis. A classification based on the analysis of 131 cases.
J Bone Joint Surg [Br].
1981;
63-B
319-327
- 8
Taeger G, Ruchholtz S, Waydhas C. et al .
Damage control orthopedics in patients with multiple injuries is effective, time saving,
and safe.
J Trauma.
2005;
59
409-417
- 9
Kotani Y, Abumi K, Ito M. et al .
Improved accuracy of computer-assisted cervical pedicle screw insertion.
J Neurosurg.
2003;
99
257-263
- 10
Bristol R, Henn JS, Dickman CA.
Pars screw fixation of a hangman's fracture: technical case report.
Neurosurgery.
2005;
56
E204
- 11
Holly LT, Foley KT.
Percutaneous placement of posterior cervical screws using three-dimensional fluoroscopy.
Spine.
2006;
31
536-541
- 12
Ito Y, Sugimoto Y, Tomioka M. et al .
Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion.
J Neurosurg Spine.
2008;
9
450-453
- 13
Börm W, König RW, Albrecht A. et al .
Percutaneous transarticular atlantoaxial screw fixation using a cannulated screw system
and image guidance.
Minim Invas Neurosurg.
2004;
47
111-114
- 14
Arand M, Hartwig E, Kinzl L. et al .
Spinal navigation in cervical fractures − a preliminary clinical study on Judet-osteosynthesis
of the axis.
Comput Aided Surg.
2001;
6
170-175
Correspondence
Y. SugimotoMD
1-3-1 Wakinohamakaigandori
Chuo-ku
651-0073 Kobe City
Japan
Phone: +81/78/231 6006
Fax: +81/78/241 7053
Email: yoshihisa64@hotmail.com
