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What Is a Hangman's Fracture?

Reviewed by Dan Brennan, MD on April 24, 2021

Your spine is made up of bones called vertebrae. The vertebrae in your neck are called cervical vertebrae, and there are 7 of them. They protect your spinal cord. A hangman's fracture is a break in the second vertebra of your neck, called the C2, or axis. This bone forms a ring around your spinal cord. A hangman's fracture occurs on both sides of this bone.

Despite its gruesome name, a hangman's fracture is rarely caused by hangings. Instead, it usually happens in car accidents, diving injuries, or contact sports injuries. 

In elderly people, a hangman's fracture can be caused by low-impact trauma as well. This is more common in people who have conditions like osteoporosis, cancer that has spread to the bones, or vitamin D deficiency. 

What Causes a Hangman's Fracture?

A hangman's fracture occurs when your head is forcefully snapped back and up. This is a hyperextension injury, meaning that your neck is extended beyond its normal range. While the biggest worry in many cases of neck fracture is damage to the spinal cord, a hangman's fracture doesn't usually damage the spinal cord at the time of the injury. 

However, it can be an unstable fracture, which means the bones might move if it's not treated. If that happens, it can damage the spinal cord, which can cause pain, paralysis, or even death. Because of this, it's important for you to be checked out by a health care provider after any type of injury in which your head is snapped up and back.  

What Are the Symptoms of a Hangman's Fracture?

Symptoms of a hangman's fracture can include: 

  • Neck pain
  • Numbness
  • Weakness
  • Bruising around the neck
  • Trouble breathing 

If your hangman's fracture is a result of an accident that caused other injuries as well, the symptoms may not be obvious right away. 

How Is a Hangman's Fracture Diagnosed?

Your doctor will do a physical exam first to check for pain or bruising. They will also check to see if you have any symptoms of spinal cord damage like numbness, weakness, or trouble breathing. You will also need imaging studies like an X-ray or a computed tomography (CT) scan. A CT scan is the best option because it can also show if the C2 bone is out of alignment with the bone below it.

Continued

You may also need magnetic resonance imaging (MRI) to diagnose a hangman's fracture. An MRI uses strong magnets, radio waves, and a computer to create detailed images. This can give your doctor a more detailed picture of the inside of your neck.

A hangman's fracture is usually classified as a particular type, depending on factors such as whether the broken bone is angled in a different direction from the bone below it, has shifted out of position, or is out of alignment with the bone below it. Knowing the type of fracture you have will help your doctor determine how it should be treated.   

How Is a Hangman's Fracture Treated?

The treatment for a hangman's fracture will depend on how bad the fracture is, including how stable it is, whether there is damage to the discs in-between the vertebrae, and whether the spinal cord is involved. There are several treatment options, including: 

External fixation. This type of treatment involves using a hard neck collar, called a cervical brace, or a halo vest. A halo vest is a type of brace that is used to keep you from moving your neck so that your fracture can heal. It includes a ring around your head held in place by pins attached to your skull. This ring is connected to a torso brace with rods. Approximately 90% of hangman's fractures heal with this treatment, which is also called immobilization.   

Internal fixation. This type of treatment is done with surgery. It's usually only done in severe cases. Surgery can realign your bones and hold them in place with screws, rods, or plates. Surgery may also be needed if your fracture doesn't heal with immobilization.    

What Is the Outcome for Hangman's Fracture?

If your hangman's fracture is treated appropriately, the chances are good for an excellent recovery. A review of 32 papers showed that the least severe type of hangman's fracture had a healing rate of 100% with immobilization alone. Another study of 30 people with hangman's fracture found that 85% had a full recovery within a year.     

WebMD Medical Reference

Sources

SOURCES:

European Spine Journal: "A systematic review of the management of hangman’s fractures."

Johns Hopkins Medicine: "Johns Hopkins Information for the patient in a Halo-Vest."

Medicine, Science, and the Law: "Cause of death in judicial hanging: a review and case study."

The Spine Hospital: "Hangman's Fracture."

StatPearls: "Anatomy, Head and Neck, Cervical Vertebrae," "Hangman's Fractures."

Summit Health: "Hangman’s Fracture with Dr. Zarro."

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