FIGURE 112.23 A: Apparently “normal” lateral cervical spine radiograph (16-year-old patient after motor vehicle accident) B: Spiral computed tomography (CT) scan demonstrating dens fracture (arrow ) C: Sagittal view of spiral CT scan demonstrating dens fracture (arrow A ) and vertebral body avulsion fracture (arrow B ) The detail demonstrated by the spiral CT scan could help clinicians quickly identify lesions not easily visible or appreciated on conventional radiographs Hangman’s Fracture The hangman’s fracture is a traumatic spondylolisthesis of C2 This injury occurs as a result of hyperextension, which fractures the posterior elements of C2 Hyperflexion, with resultant ligamentous damage, may follow the hyperextension or may lead to anterior subluxation of C2 on C3 and subsequent damage of the cervical cord ( Fig 112.24 ) The subluxation associated with a hangman’s