Caspar plate fixation for the treatment of complex hangman’s fractures

This report details our recent experience with the surgical treatment of complex hangman’s fractures after failure of closed reduction and immobilization in external orthosis. We have successfully treated hangman’s fractures in 5 patients with anterior Caspar plate stabilization and C2-C3 interbody fusion. The specific anatomical features of these fractures were complex, rendering the spines of the patients highly unstable. The patients were considered surgical candidates when reduction could not be achieved or maintained with axial traction or halo immobilization. Each patient underwent anterior C2-C3 interbody bone fusion and Caspar plating from C2 to C3. All patients achieved adequate intraoperative reduction and were immobilized postoperatively with a halo vest. The follow-up period ranged from 3 to 28 months and provided a 100% fusion rate with no complications related to plating or nonunion. Our initial experience indicates that anterior C2-C3 interbody bone fusion and Caspar plate fixation is a suitable treatment option for patients with complex hangman’s fractures who are not successfully managed nonoperatively.