Traumatic spondylolisthesis of C2 occurs when the mechanical event at the base of the trauma is a compression force on the vertex. Management of this is well defined in literature, and both surgical and conservative treatments have been proposed in adults. In contrast, the principles of treatment are somewhat more uncertain and less well defined in children. One of the most frequently suggested treatments is the early reduction of the fracture, with immobilization in halo. Other types of cervical orthoses are not recommended. This article reports on a rare case of an inveterate hangman’s fracture in a 12-year-old girl that is healing completely through immobilization in a SOMI brace that was applied 4 months after the trauma. In our experience, hangman’s fracture is poorly defined with regard to the treatment of pediatric patients, and there are currently no established guidelines. If dynamic X-ray scans show complete reduction of the fracture, conservative treatment is an efficient, effective, and noninvasive solution, even in case of inveterate fractures. Halo vest and SOMI brace are good solutions. SOMI brace is an available option because it is less traumatic for the patient.
Chittiboina P, Wylen E, Ogden A, Mukherjee DP, Vannemreddy P, Nanda A. Traumatic spondylolisthesis of the axis: a biomechanical comparison of clinically relevant anterior and posterior fusion techniques. J Neurosurg Spine. 2009;11:379–87.
Duggal N, Chamberlain RH, Perez-Garza LE, Espinoza-Larios A, Sonntag VK, Crawford NR. Hangman’s fracture: a biomechanical comparison of stabilization techniques. Spine (Phila Pa 1976) 2007;32:182–7.
ElMiligui Y, Koptan W, Emran I. Transpedicular screw fixation for type II hangman’s fracture: a motion preserving procedure. Eur Spine J. 2010;19:1299–305.
Hakało J, Wroński J. Operative treatment of hangman’s fractures of C2. Posterior direct pars screw repair or anterior plate-cage stabilization? Neurol Neurochir Pol. 2008;42:28–36.
Junge A, El-Sheik M, Celik I, Gotzen L. Pathomorphology, diagnosis and treatment of “hangman’s fractures”. Unfallchirurg. 2002;105:775–82 [in German].
Landi A, Pietrantonio A, Marotta N, Mancarella C, Delfini R. Atlantoaxial rotatory dislocation (AARD) in pediatric age: MRI study on conservative treatment with Philadelphia collar – experience of nine consecutive cases. Eur Spine J. 2012;21:S94–9.
Li XF, Dai LY, Lu H, Chen XD. A systematic review of the management of hangman’s fractures. Eur Spine J. 2006;15:257–69 [review].
Ramieri A, Domenicucci M, Landi A, Rastelli E. Raco conservative treatment of neural arch fractures of the axis: computed tomography scan and X-ray study on consolidation time. World Neurosurg. 2011;75:314–9.
Ranjith RK, Mullett JH, Burke TE. Hangman’s fracture caused by suspected child abuse. A case report. J Pediatr Orthop B. 2002;11:329–32.
Smith MD, Phillips WA, Hensinger RN. Fusion of the upper cervical spine in children and adolescents. An analysis of 17 patients. Spine (Phila Pa 1976). 1991;16:695–701.
Stulík J, Nesnídal P, Kryl J, Vyskočil T, Barna M. Unstable injuries to the upper cervical spine in children and adolescents. Acta Chir Orthop Traumatol Cech. 2013;80:106–13 [in Czech].
Xu H, Zhao J, Yuan J, Wang C. Anterior discectomy and fusion with internal fixation for unstable hangman’s fracture. Int Orthop. 2010;34:85–8.