Hangman's fracture

This fracture may be produced in two ways;

• Simultaneous extension and distraction of the neck as occurs in hanging and in motorcyclists caught under the neck by a tree branch. Treatment involves skull traction for 4 to 6 weeks to maintain position with the possibility of local fusion (posterior or anterior).
• Extension of the neck with compression. This pattern of injury occurs in road traffic accidents where the head hits the roof of the car (compression) and is then thrown into extension. Treatment depends on the stability of the injury. Stable injuries can be treated with a well-fitting collar for 6 weeks. If there is neurological injury or instability skull traction and or local fusion are indicated.

Neurological damage is common in the first case but rare in the second.