TITLE:
Nakamura-Tracana Technique Based on Newton’s Third Law Applied to Stabilize Hangman Type Iii Cervical Fracture: The First Case in Latin America
AUTHORS:
Yiro Nakamura Cardemil, Luis Tracana, Freddy Medina
KEYWORDS:
Hangman Fracture, Cage, Self-Locking Screw, Opposing Vectors
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.16 No.2,
February
26,
2026
ABSTRACT: Hangman’s fracture or spondylolisthesis of the axis, are traumatic injuries to the C2 neural arch. They represent only 4% - 5% of cervical fractures, although they are often referred to as Hangman’s fractures worldwide due to their radiological similarity. It is important to note that the two occur through different mechanisms. We report the case of a male patient in his thirties who, following a high-energy car accident and rollover, presented with polytrauma. Neurological examination revealed no motor deficits; only paresthesia in the right upper extremity was noted, with a GCS score of 15. A neurotrauma imaging protocol was performed, diagnosing a Hangman type III fracture. The patient was transferred to the ICU and traction (5 pounds) was applied using a Gardner-Wells frame. A follow-up cervical CT scan showed a reduction of the C2/3 segment. The patient was taken to the operating room while maintaining cervical traction. The surgical approach involved an anterior retropharyngeal cervicotomy, C2/3 discectomy, and fusion with a titanium cage and self-locking screw. During this surgical step, the locking screw of the cage did not fit the C2 body properly, as the craniocervical junction moved away when attempting to insert it. Therefore, in this work, we describe an ad hoc technique that, for the first time, allowed the placement of a self-locking screw in this pathology, thanks to Newton’s theory of opposing vectors. After this surgical technique, the patient progressed satisfactorily with total reduction of C2/3 spondylolisthesis, great biodynamic stability, and a high level of fusion, with 24 months of postoperative follow-up without neurological deficits.