Evidence map›Paper›PMID 41793500›Full record

SynthesisEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026

Surgical versus conservative management of Hangman's fractures: a meta-analysis.

Marc Boutros, Guy Awad, Christèle Asmar, Jad Lawand, Antoine Mouawad, Jad Bou Monsef

Abstract readComparative StudyMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Marc BoutrosFaculty of Medicine, Saint Joseph University, Beirut, Lebanon. marceboutros@gmail.com.
Guy AwadFaculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Christèle AsmarFaculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Jad LawandThe University of Texas Medical Branch at Galveston, Galveston, USA.
Antoine MouawadFaculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Jad Bou MonsefDepartment of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionHangman’s fracture, defined as a bilateral pars interarticularis fracture of C2, is a common cervical spine injury treated either conservatively or surgically depending on fracture stability and displacement. Conservative immobilization often provides satisfactory fusion in stable patterns, whereas operative fixation is increasingly used in unstable injuries. Despite widespread use of both approaches, evidence comparing long-term outcomes and complication profiles remains inconsistent. This study aimed to compare surgical versus conservative management of Hangman’s fractures with respect to union and treatment-related complications through a meta-analysis of comparative studies.

methodsA systematic review was conducted in accordance with PRISMA and Cochrane Collaboration standards. PubMed, Scopus, Cochrane Library, and Google Scholar were searched through November 2025. Comparative clinical studies evaluating adult patients with traumatic Hangman’s fractures treated operatively or nonoperatively were included. Methodological quality and risk of bias were assessed using the ROBINS-I tool. Six retrospective studies comprising 197 adults (11–62 per study) met eligibility criteria.

resultsAll included studies had an overall moderate risk of bias. Surgical and conservative management did not differ significantly in rates of nonunion (RR = 4.33; p = 0.09), treatment failure including conversion or revision (RR = 2.19; p = 0.18), posttreatment stiffness (RR = 0.98; p = 0.95), infection (RR = 0.42; p = 0.21), neurologic complications (RR = 1.03; p = 0.97), or one-year mortality (RR = 1.64; p = 0.65). Conservative management demonstrated significantly fewer miscellaneous complications such as delirium, DVT, and dysphagia (RR = 0.46; p = 0.002).

conclusionBased on observational evidence, nonoperative treatment of Hangman’s fractures achieves outcomes comparable to surgical fixation regarding union, neurological preservation, and functional recovery, with fewer treatment-related complications in appropriately selected, stable patients, whereas surgical stabilization remains necessary for unstable fractures or in patients for whom prolonged immobilization is unsuitable. Additional prospective randomized studies are needed to refine patient selection and enhance individualized management strategies.

Indexed as

Cervical VertebraeConservative TreatmentFracture FixationSpinal FracturesHumansPostoperative ComplicationsC2 fractureCervical spine traumaConservative managementHangman’s fractureSurgical fixation

Identifiers

PMID41793500

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.