Analysis of clinical features of Hangman′s fracture caused by motor vehicle accidents: a retrospective study based on multicenter clinical data

English Keywords:Hangman′s fracture  Clinical features  Multicenter studies  Retrospective study  Motor vehicle accident

English Abstract:

  【Abstract】 Objectives: To analyze the clinical features in patients with Hangman′s fracture caused by motor vehicle accidents. Methods: The clinical records of Hangman′s fracture patients caused by motor vehicle accidents were extracted from multicenter Hangman′s fracture database(Data from 7 medical centers such as the Affiliated Hospital of Southwest Medical University and West China Hospital of Sichuan University, etc), and the data of gender, age, fracture type(Levine-Edwards classification), combined injury, and treatment were systematically analyzed. Results: A total of 72 eligible patients were selected from the total 221 patients in the database, including 52 males and 20 females(Male to female ratio was 2.6∶1), with an average age of 41 years(15-71 years old, 93.1% of young and middle-aged patients ≤ 64 years old). According to the Levine-Edwards classification, 46 cases out of the 72(63.9%) were of unstable fractures(Type Ⅱ, 35 cases; Type Ⅱa, 7 cases; Type Ⅲ, 4 cases) and 26 cases were of stable fractures. According to the anatomical classification of axial ring fractures, 52 cases were of atypical Hangman′s fracture(72.2%) which affecting the superior facet of unilateral or bilateral C2 and/or the posterior wall of the vertebral body(Type B1 fracture, 20; B2 fracture, 26; C1 fracture, 4; C2 fracture, 2), and the other 20 cases were of typical Hangman′s fracture characterized with unilateral or bilateral pars interarticularis-pedicle fracture(Type A1, 5; Type A2, 15). A total of 69 patients had combined injuries, with an incidence rate of 95.8%, including 44 cases of combined head and facial injuries(61.1%), 38 cases of spinal and pelvic related injuries(52.8%), 25 cases of chest injuries(34.7%), and 19 cases of limb fractures(26.4%). A total of 26 patients(36.1%) combined with injuries in the above three sites or more. In terms of the choice of treatment methods, a total of 43 patients(59.7%) underwent internal fixation surgery(9 cases of anterior, 33 cases of posterior and 1 case of combined anterior and posterior surgery). Conclusions: Young and middle-aged males are the main population injured in Hangman′s fracture caused by motor vehicle accidents, with unstable and atypical fractures as the main, and most of them have concurrent injuries in other parts. A large majority of the patients need to undergo surgical treatment, mainly through posterior fixation and fusion.