ArticleGlobal spine journal2018
Treatment of Axis Ring Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU).
Article in Global spine journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 73 citations in OpenAlex.
- Management of Atypical Hangman's Fracture (C2 Axis): Systematic Review of Classification, Treatment Strategies, and Clinical Outcomes.Medicina (Kaunas, Lithuania) · 2026Pooled it
- Transoral Approach With Reverse Pedicle Screw Technique for the Treatment of Chronic Levine-Edwards Type III Hangman's Fracture: A Case Report, Surgical Technique, and Literature Review.International journal of spine surgery · 2026Article
- The surgical treatment of upper cervical spine trauma in octogenerians.Brain & spine · 2025Article
- Enhancing C2 pedicle screw placement in Hangman's fractures: a comparative study of navigation and 3D printed guidance techniques.Frontiers in surgery · 2025Article
- Analysis of the clinical characteristics and predisposing factors for neurological deficit with Hangman fractures.Journal of orthopaedic surgery and research · 2023Article
- Detailed observation of anatomical location and pattern in Hangman's fracture based on computed tomography three-dimensional reconstruction.Journal of orthopaedic surgery and research · 2023Article
- Is it feasible to treat unstable traumatic spondylolisthesis of the axis via posterior fixation without fusion?BMC musculoskeletal disorders · 2023Article
- Analysis of the clinical characteristics of adult patients with hangman's fractures: A retrospective study based on multicenter clinical data.Frontiers in surgery · 2023Article
- Fractures of C2 (Axis) Vertebra: Clinical Presentation and Management.International journal of spine surgery · 2020Article
- [Minimally invasive techniques for traumatic injuries of the cervical spine].Der Unfallchirurg · 2020Review
- Article
- Saradhi's single stage, anterior sequential reduction utilizing C3 for type III hangman's fracture: A novel technique.Journal of craniovertebral junction & spineArticle
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
designNarrative literature review and expert recommendation.
objectiveTo establish treatment recommendations for axis ring fractures based on the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma.
methodsThis recommendation summarizes the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma with regard to the treatment of axis ring fractures based on a narrative literature review.
resultsTypical "hangman's fractures" with bilateral separation of the neural arch from C2 and atypical "hangman's fractures" with irregular fracture morphology are described. Computed tomography is the "gold" standard used to detect and analyse these fractures adequately. Furthermore, the detection of vertebral artery integrity is necessary. To classify axis ring fractures, the Levine-Edwards or Josten classification is recommended. In particular, the integrity of the C2/3 disc and the integrity of the anterior longitudinal ligament are used to determine the treatment strategy. While Levine-Edwards type I and type IIA (Josten type 1 and 2) fractures should be treated conservatively, Levine type II and type III (Josten type 3 and 4) fractures should be treated operatively. Levine-Edwards type II fractures will be predominately treated by anterior C2/3 fusion. Levine-Edwards type III fractures have to be primary reduced, if an anterior fusion is planned (anterior cervical discectomy and fusion [ACDF] C2/3). If a closed reduction of a type III fracture is impossible, an open reduction and posterior fixation/fusion is the treatment of choice.
conclusionConservative treatment is predominantly reserved for Levine-Edwards I and IIA fractures. Operative treatment should be performed in case of Levine-Edwards II and III fractures.
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