Biomechanical differences between Hangman's fracture and its various surgical treatment strategies

doi:10.13418/j.issn.1001-165x.2025.4.22

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Chinese Journal of Clinical Anatomy ›› 2025, Vol. 43 ›› Issue (4) : 491-497. DOI: 10.13418/j.issn.1001-165x.2025.4.22

Biomechanical differences between Hangman's fracture and its various surgical treatment strategies

He Yinghua¹, Liu Yansong¹, Liang Zhongbiao¹, Sun Hao², Chen Hu³, Xie Ningling³, Tu Qiang^1,2,3*

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Abstract

To systematically evaluate the biomechanical characteristics of various types of Hangman's fractures and their corresponding treatment strategies, thereby providing an evidence-based foundation for clinical decision-making. Relevant literature was retrieved and analyzed from databases such as PubMed and CNKI (China National Knowledge Infrastructure) using the keywords "Hangman" and "biomechanics."The results indicated that non-surgical treatment for stable fractures (Type I) and surgical intervention for unstable fractures (Types II, IIa, and III) can achieve favorable biomechanical stability and long-term outcomes, provided the fracture is accurately classified. Hangman's fractures can be divided into stable and unstable types, and both anterior and posterior surgical approaches are effective in restoring cervical spine stability.Biomechanical analyses have demonstrated that in cases involving injuries to the anterior longitudinal ligament and intervertebral disc, C2~3 anterior cervical discectomy and fusion (ACDF) offers superior immediate stability. Posterior single-segment physiological fixation preserves C1~2 rotational function to the greatest extent but fails to address C2~3 instability. In contrast, posterior C2~3 fixation and fusion provides higher mechanical stiffness and more effectively stabilizes the fracture site. C1~3 long-segment fixation and fusion offers greater stiffness and multidirectional stability in flexion-extension, lateral bending, and rotational movements. However, it compromises atlantoaxial mobility-a drawback that can be mitigated by employing temporary long-segment fixation.

Key words

Hangman fracture / / / Biomechanical analysis / / / Anterior surgery / / / Posterior surgery

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He Yinghua, Liu Yansong, Liang Zhongbiao, Sun Hao, Chen Hu, Xie Ningling, Tu Qiang. Biomechanical differences between Hangman's fracture and its various surgical treatment strategies[J]. Chinese Journal of Clinical Anatomy. 2025, 43(4): 491-497 https://doi.org/10.13418/j.issn.1001-165x.2025.4.22

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