Pediatric emergency medicine trisk 3604 3604

FIGURE 112.23 A: Apparently “normal” lateral cervical spine radiograph (16-year-old patient
after motor vehicle accident). B: Spiral computed tomography (CT) scan demonstrating dens
fracture (arrow ). C: Sagittal view of spiral CT scan demonstrating dens fracture (arrow A ) and
vertebral body avulsion fracture (arrow B ). The detail demonstrated by the spiral CT scan could
help clinicians quickly identify lesions not easily visible or appreciated on conventional
radiographs.

Hangman’s Fracture
The hangman’s fracture is a traumatic spondylolisthesis of C2. This injury occurs
as a result of hyperextension, which fractures the posterior elements of C2.
Hyperflexion, with resultant ligamentous damage, may follow the hyperextension
or may lead to anterior subluxation of C2 on C3 and subsequent damage of the
cervical cord ( Fig. 112.24 ). The subluxation associated with a hangman’s