Levine and Edwards classification
Levine and Edwards classification is used to classify Hangman's fracture of C2 (also known as traumatic spondylolithesis of axis).
Classification
Levine Classification: (does not apply to children);
Type III: Includes all characteristics of type II frx as well as bilateral interfacetal dislocation; may require open reduction of facet dislocation halo immobilization for the pedicle injury; type III has angulation, translation, and also unilateral or bilateral facet dislocation at C2-3.
- Non Operative Rx: Halovest
Pts w/ Hangman's fx should not be placed in cervical traction if mechanism of injury involves extension or distraction;
Children: traction should generally be avoided; reduction is obtained w/ gentle extension; some residual displacement may be accepted; need to immobilize in halo for 6-8 weeks;
Surgical Treatment: ORIF may be necessary to obtain and maintain reduction; internal fixation techniques include posterior oblique wiring, which resists rotational forces, & screw fixation of C-2 posterior elements to the C-2 body.
This latter technique depends on integrity of C-2 & C-3 capsules and ligaments, which is usually the case.