Hangman’s Fracture in Geriatric Population: A Nationwide Multicenter Study in Japan

Global Spine Journal, 2025 · DOI: 10.1177/21925682231216925 · Published: February 1, 2025

Aging Orthopedics Musculoskeletal Medicine

Simple Explanation

This study looks at Hangman's fractures, which are specific breaks in the neck, in older adults (65+). It uses a large database from multiple hospitals in Japan to understand how these fractures are treated. The study examines different types of Hangman's fractures and whether surgery or conservative treatment (like wearing a neck brace) leads to better outcomes, such as the bones healing properly and shorter hospital stays. The research also investigates how often these fractures cause spinal cord injuries in older adults and highlights the importance of considering other injuries that may occur at the same time.

Study Duration

January 2010 and March 2021

Participants

1512 patients, patients over 65 years old, requiring hospitalization, and follow-up for at least 3 months

Evidence Level

Retrospective multicenter study

Key Findings

1
The bony fusion rate for hangman’s fractures in the geriatric population was high, around 90% for Type I and Type II fractures.
2
Surgical treatment for Type II fractures resulted in significantly shorter hospital stays compared to conservative treatment.
3
A notable percentage (21%) of geriatric patients with hangman’s fractures experienced spinal cord injuries, emphasizing the risk in this population.

Research Summary

This study investigates the treatments and outcomes of hangman’s fractures in geriatric patients using a large multicenter database in Japan. The study reveals a high bony fusion rate with appropriate treatment and demonstrates that surgical intervention for Type II fractures leads to shorter hospital stays. It also emphasizes the risk of spinal cord injuries associated with hangman’s fractures in the geriatric population, challenging previous assumptions.

Practical Implications

Treatment Strategy

Surgical intervention should be strongly considered for Type II hangman's fractures in geriatric patients to reduce hospitalization duration.

Risk Awareness

Clinicians should be aware of the increased risk of spinal cord injuries in geriatric patients with hangman's fractures.

Comprehensive Assessment

A thorough assessment for associated cervical spine injuries is crucial in geriatric patients with hangman's fractures to guide treatment planning.

Study Limitations

1
The study relies on a multicenter database, limiting detailed examination of individual cases.
2
Classification of atypical cases with fracture lines extending into the vertebral body may not be consistent across institutions.
3
The minimum follow-up duration of 3 months may not be sufficient to assess long-term complications.

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