Pediatric hangman's fracture: A comprehensive review

Purpose: Over 170 years ago, traumatic spondylolisthesis of the axis or hangman's fracture was described. Most descriptions of this entity have focused on adult presentations. Methods: We review the literature on pediatric cases of hangman's fracture emphasizing the embryological as well as presentation aspects. Results: The majority of cervical spine fractures in children occur at C₁ and C₂ vertebrae. A normal anterolisthesis of C₂ can be seen in younger children and can mimic the anterolisthesis seen after traumatic spondylolisthesis. Conclusions: Traumatic spondylolisthesis of the axis in children requires further investigation due to the current emphasis in the literature on adult clinical findings and diagnostic challenges from the developmental immaturity of the pediatric skeleton.