Hangman’s Fracture with Concomitant Atlantoaxial Dislocation: a ‎Case Report

Background: Concomitant Hangman’s fracture and atlantoaxial subluxation is a rare phenomenon. Herein, we reported a victim of motor vehicle crash with traumatic spondylolisthesis of the axis and atlantoaxial rotatory dislocation. Case presentation: the patient was a 32 years old female with a chief complaint of severe neck pain and normal neurologic examination except for mild torticollis. Imaging revealed anterolisthesis of the C2 over C3 with angulation of C1/C2 and rupture of C2/C3 disc while integrity of transverse ligament is preserved. After partial close reduction with traction, the patient was operated. A 360-degree approach was selected, anterior discectomy of C2/C3 with cage and plate insertion was followed by posterior fixation using C1, C3 and C4 lateral mass screws. One-year follow-up radiography depicted proper fusion and alignment. Conclusion:  Paucity of evidence regarding simultaneous atlantoaxial dislocation and Hangman’s fracture made its management challenging. The mechanism of injury is probably hyperextension and rotation. Based on our presented case, anteroposterior fixation resulted in long term satisfactory outcome, both clinically and radiologically.