Study design: Prospective Study.
Objective: To study the results of direct repair of type 2 hangman fracture using Iso-C3D navigation.
Summary of background: Direct fixation of axis pedicle fracture gives biomechanically stronger stability and early mobilization. These fixations are technically demanding. Very few cases of direct fixation using Iso-C3D navigation are reported. We report the largest series of directly fixed hangman fractures so far.
Materials and methods: Twenty type 2 hangman fractures (18 men and 2 women), in age group of 17-63 years (average, 38 y), were treated by posterior direct repair using Judet screws under Iso-C3D navigation. Twelve had road traffic accident, 7 had fallen from height, and 1 had direct injury to head. Nine had limb or pelvic fractures. Eighteen patients had normal, 2 had ASIA D, and 1 had ASIA B neurology.
Results: With no intraoperative complications, 18 patients underwent bilateral pedicle fixation and 2 underwent unilateral fixation, with an average blood loss of 220 mL. Average follow-up was 29 months. Postoperative images showed good reduction with union in an average of 8 weeks. Average anterior translation of 3.2 mm preoperatively was reduced to 1.0 mm postoperatively. Computed tomography axial cuts distance with an average of 3.57 mm on right side and 3.66 mm on left side were reduced to 0.40 and 0.46 mm postoperatively. Two cases presenting with pseudoarthrosis showed consolidation after 25 weeks of surgery. Visual analog score of 7 preoperatively reduced to 1 by 8 weeks, 0 by 20 weeks postoperatively, except in 2 patients. In one patient, screws were removed after 8 months postoperatively and in other patient pain subsided gradually by 7 months. According to Myung-Sang Moon Assessment Criteria, 14 had excellent, 3 had good, 2 had fair, and 1 had poor results. P value was significant for visual analog score and postoperative reduction distance.
Conclusions: Use of Iso-C navigation allows safe direct fixation of hangman fractures.