Evidence brief
Management of Hangman's Fractures
Type I: <3mm displacement, no angulation - stable, collar
Type II: >3mm displacement and angulation - unstable, halo/surgery
Type IIA: minimal displacement, severe angulation - traction contraindicated
Type III: C2-3 facet dislocation - unstable, surgery
Mechanism: hyperextension-axial loading vs flexion-distraction
The Levine-Edwards classification guides management of hangman's fractures from conservative (Type I) to surgical (Type III), with careful consideration of mechanism.
Classic cervical spine viva topic. Know the types and treatment. Critical: Type IIA has angulation but minimal translation - traction makes it worse! Look for disc injury on MRI. Type III requires surgery due to facet dislocation.
Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am. 1985;67(2):217-226.
Level IV
Case series or case reports