Surgical management of a type III Hangman’s fracture in a pregnant patient: a case report

Background

Spinal trauma during pregnancy is uncommon and requires individualized management because treatment decisions must balance maternal neurological stability with fetal safety. Physiological and biomechanical changes in pregnancy, together with concerns related to diagnostic imaging, anaesthesia, operative timing, and positioning, make unstable cervical spine injuries particularly challenging. Type III Hangman’s fracture is a highly unstable cervical injury that may require surgical stabilisation. Case summary: We report the case of a 32-year-old pregnant woman who presented with a 10-week history of persistent posterior neck pain following trauma secondary to gender-based violence. Initial evaluation revealed a Type III Hangman's fracture with C2–C3 dislocation and an associated right C3 lateral mass fracture. She was neurologically intact, and obstetric assessment confirmed a viable intrauterine pregnancy at 12 weeks of gestation. Because of the early gestational age and absence of neurological deficit, she was initially managed conservatively with a rigid cervical collar. At follow-up 8 to 10 weeks later, she had persistent symptoms, collar-related complications, and repeat cervical CT confirmed ongoing instability. She underwent posterior C1–C5 fixation during the second trimester with maternal–foetal safety precautions. Her postoperative course was uneventful, foetal assessment remained reassuring, and she later delivered a healthy male infant by caesarean section.