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A novel classification for atypical Hangman fractures and its application: A retrospective observational study.

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28700494
OWN - NLM
STAT- MEDLINE
DA  - 20170712
DCOM- 20170724
LR  - 20170729
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 28
DP  - 2017 Jul
TI  - A novel classification for atypical Hangman fractures and its application: A
      retrospective observational study.
PG  - e7492
LID - 10.1097/MD.0000000000007492 [doi]
AB  - 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.
FAU - Li, Guangzhou
AU  - Li G
AD  - Department of Spine Surgery, the Affiliated Hospital of Southwest Medical
      University, Luzhou Sichuan, China.
FAU - Zhong, Dejun
AU  - Zhong D
FAU - Wang, Qing
AU  - Wang Q
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Axis, Cervical Vertebra/diagnostic imaging/*injuries/surgery
MH  - Diskectomy
MH  - Female
MH  - Follow-Up Studies
MH  - Fracture Fixation, Internal
MH  - Humans
MH  - Incidence
MH  - Joint Instability/diagnostic imaging/epidemiology/etiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Spinal Fractures/*classification/diagnostic imaging/epidemiology/surgery
MH  - Spinal Fusion
MH  - Young Adult
PMC - PMC5515766
EDAT- 2017/07/13 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/07/13 06:00
AID - 10.1097/MD.0000000000007492 [doi]
AID - 00005792-201707140-00032 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(28):e7492. doi: 10.1097/MD.0000000000007492.