Comparison of posterior C2-3 fixation combined with bucking bar technique and posterior C2-3 fixation alone in treatment of unstable Hangman fractures

doi:10.12307/2025.120

Abstract

Abstract:

BACKGROUND: Types II, IIA, and III of Hangman fractures often require surgical treatment, and the selection of surgical methods is controversial. Current surgeries have shortcomings such as incomplete reduction and malunion after surgery. In the early stage, our team used C2-3 lag screws combined with a bucking bar. Intermittent pushing of the C2 vertebral body in the oropharynx has achieved satisfactory clinical results. However, the preliminary studies included few samples and lacked a control group for comparison.

OBJECTIVE: To compare the clinical efficacy of posterior C2-3 fixation combined with the bucking bar technique and posterior C2-3 fixation alone in the treatment of unstable Hangman fractures.
METHODS: The clinical and imaging data of 55 patients with unstable Hangman fractures who underwent posterior C2-3 internal fixation in Affiliated Hospital of Southwest Medical University were retrospectively analyzed. According to the surgical plan, the patients were divided into two groups. Among them, 23 patients received posterior cervical C2-3 internal fixation combined with the bucking bar technique (group A), and 32 patients received simple posterior C2-3 internal fixation (group B). Operation time, intraoperative blood loss, complications, pain visual analog scale score, neck disability index, American Spinal Injury Association classification, and patient satisfaction (Odom’s classification) preoperation and during follow-up were compared between the two groups. The changes in C2-3 displacement and angulation and other imaging indicators were compared at each observation time point.

RESULTS AND CONCLUSION: (1) There was no statistically significant difference in operation time, intraoperative blood loss, and postoperative complications between the two groups (P > 0.05). (2) The neck pain visual analog scale and neck disability index scores of the two groups of patients at the final follow-up were significantly improved compared with those before surgery (P < 0.05). The Odom standard classification showed that 21 cases (91%) in group A were excellent and 29 cases (91%) were excellent and good in group B. There was no statistically significant difference in the clinical efficacy indicators between the two groups (all P > 0.05). (3) There was no significant difference in C2-3 angulation and displacement between the two groups before operation (P > 0.05). Postoperation and at the last follow-up, the angle and displacement of C2-3 in both groups were significantly smaller than before surgery, and the difference was statistically significant (P < 0.01). There was no statistically significant difference in the above indicators after surgery and at the last follow-up (P > 0.05). After surgery and at the last follow-up, the displacement and angle of C2-3 in group A were significantly smaller than those in group B (P < 0.05). (4) At the last follow-up, no patients in group A had residual deformity, and 4 cases (13%, 4/32) in group B had residual deformity. (5) Therefore, posterior C2-3 fixation combined with transoral bucking bar technology may be beneficial to the reduction and stabilization of the vertebral body, reduces malunion, and can achieve better reduction.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Hangman’s fracture, bucking bar technique, posterior lag screw, fracture reduction, internal fixation

CLC Number:

R459.9|R318|R681

Zhang Hao, Wang Qing, Zhang Jian, Li Guangzhou, Wang Gaoju. Comparison of posterior C2-3 fixation combined with bucking bar technique and posterior C2-3 fixation alone in treatment of unstable Hangman fractures[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(9): 1848-1854.

Figures/Tables 5

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