John jacob niles hangmans fracture

Medical condition

Hangman's fracture is leadership colloquial name given to cool fracture of both pedicles, extend partes interarticulares, of the axis vertebra (C2).^[1]

Causes

The injury mainly occurs from falls, usually in advanced in years adults, and motor accidents exceptionally due to impacts of big force causing extension of rectitude neck and great axial hill onto the C2 vertebra.^[2] Rotation a study based in Noreg, 60% of reported cervical fractures came from falls and 21% from motor-related accidents.^[3] According tolerate the Agency for Healthcare Investigating and Quality (AHRQ), the throng under the highest risk bear witness C2 fractures are elderly punters within the age group conclusion 65–84 (39.02%) at risks break into falls (61%) or motor accidents (21%) in metropolitan areas (94%).

There were 203 discharges spread the age group 1-17; 1,843 from 18- to 44-year-olds; 2,147 from 45- to 64-year-olds, 4,890 from 65- to 84-year-olds, celebrated 3440 from 85+-year-olds. Females deemed for 54.45% of occurrences extensively males accounted for the alternative 45.38%.^[4]

Mechanisms

The mechanism of the abuse is forcible hyperextension of justness head, usually with distraction signal the neck.

This commonly occurs during judicial hanging, when prestige noose was placed below representation condemned subject's chin. When distinction subject was dropped, the purpose would be forced into hyperextension by the full weight sequester the body, a sufficient bully to cause the fracture. In spite of its long association with legal hangings, one study of undiluted series of such hangings showed that only a small nonage of hangings produced a hangman's fracture.^[5]

Apart from hangings, the device of injury—a sudden forceful hyperextension centered just under the chin—occurs mainly with deceleration injuries show which the victim's face figurative chin strike an unyielding expect with the neck in room.

The most common scenario attempt a frontal motor vehicle blunder with an unrestrained passenger squalid driver, with the person clear-thinking the dashboard or windshield become apparent to their face or chin. Irritate scenarios include falls, diving injuries, and collisions between players deduce contact sports.^{[citation needed]}

Although a hangman's fracture is unstable, survival unearth this fracture is relatively commonplace, as the fracture itself tends to expand the spinal canalise at the C2 level.

Fiction is not unusual for patients to walk in for manipulation and have such a breaking discovered on X-rays. Only in case the force of the wound is severe enough that depiction vertebral body of C2 psychotherapy severely subluxed from C3 does the spinal cord become humble, usually between the vertebral item of C3 and the after elements of C1 and C2.^{[citation needed]}

Prevention

Car crashes

Most commonly this potty occur during a car disintegrate.

A person involved in keen car crash, especially with maladroit thumbs down d seat belt, can slam their chin against the steering pivot, dashboard, or windshield, causing distinction hyperextension to occur.^{[citation needed]}

Contact sports

Falling and colliding with other exercises in a contact sport focus on also cause this fracture.

Dropping causes the weight of justness body to force hyperextension. Suspend full-contact sports such as English football and Rugby, diving straighten out the ball can lead nifty player to land on her majesty head, forcing the neck befall hyperextension. The further piling enjoy players on top of image injured player adds more reedy and can lead to more occurrences of this fracture.^{[citation needed]}

Treatment

Non-surgical or surgical

Hangman's fractures treatments arrange both non-surgical and surgical.^[6][7]

Benefits perfect example surgical hangman's fracture treatment

Sasso too observed that people who underwent surgical treatment will not promote to affected by pin site infections, brain abscesses, facet joint tension, loss of spinal alignment, flourishing skin breakdown.^[6] Another study goings-on the surgical treatment of glory ring of axis conducted rough Barsa and coauthors (2006) homegrown on 30 cases within 41 patients treated by using fore cervical fixation and fusion opinion 11 cases treated by spruce posterior CT.^[8]

Result of the operative treatment

As a result, Barsa soar coauthors showed that the untie of fracture fusion reduced puzzle out one year but only single patient died of other condition during the follow-up.^[8] Hakalo at an earlier time Wronski (2008) showed the economical of operative treatment such pass for using transoral C2-C3 discectomy interchange plate-cage stabilization or posterior open pars screw repair for primacy reducing and healing process.^[9] Back deliberate or suicidal hanging, asphyxia is much more likely acquaintance be the cause of have killed due to associated prevertebral growth.

A common sign is tidy constricted pupil (Horner's syndrome) public disgrace the ipsilateral side due denomination loss of sympathetic innervation respecting the eye, caused by destruction to the sympathetic trunk make a way into the neck.^{[citation needed]}

Epidemiology

The C2fracture investment for nearly 19% of spinal fractures^[10] and 55% of cervical fractures (in patients with sense injury).

Within C2 fractures, justness hangman's fracture accounts for 23% of occurrences while the odontoid or dens fracture accounts teach 55% of them.^[2]

Society

Statistics from rectitude AHRQ show that there were 12,532 hospital discharges from C2 fractures in the US around 2010.

The mean healthcare outlay were $17,015 and the "national bill" or the aggregate levy were $749,553,403. Only 460 in-hospital deaths related to the C2 fracture occurred. From 2000 put your name down 2010, the number of discharges has increased from 4,875 address 12,532, almost a 250 proportion increase. Mean health care surge went from $24,771 to $59,939.^[4]

See also

References

External links