View lateral neck radiograph. The hangman's fracture is an unstable fracture of the C2 pedicles, with forward displacement of C1 and the body of C2 on C3. This traumatic spondylolisthesis of C2 is the result of hyperextension of the head relative to the neck. The return to neutral position will then cause the body of C2 to become anteriorly displaced over C3. Lateral neck radiographs are extremely helpful, and the fracture of the neural arch is usually easily seen.
Oblique views are also helpful.
AP views do not contribute much. CT scans are not as helpful as in other cervical fractures. It is essential to properly identify a hangman's fracture. View the anatomic markers on the lateral neck radiograph. In the lateral neck radiograph of a hangman's fracture, the C2 vertebral body is displaced superiorly, and the inferior articular facets of C2 are displaced inferiorly.