From the Guidelines
Hanging attempts are commonly associated with cervical spine injuries, including fractures and dislocations, as well as ligamentous injuries 1.
Typical Injuries
- The most frequent injuries observed are C2 (axis) fractures, particularly hangman's fractures, which occur due to the hyperextension and distraction of the cervical spine.
- Victims may also experience spinal cord injuries, resulting in neurological deficits, and in severe cases, respiratory failure may occur due to high cervical spine injury.
Risk Factors
High-energy transfer mechanisms, such as those involved in hanging, increase the risk of cervical spine injuries, including fractures at C1-3 or those that involve the transverse foramen at any level 1.
Clinical Considerations
It is essential to consider the potential for cervical spine subluxation/dislocation and cervical spine fractures in patients who have attempted hanging, as these injuries can have severe and long-lasting consequences 1.
From the Research
Typical Injuries in Hanging
- The typical injury in a hanging is not commonly found in short-drop suicidal hanging, occurring in only 3.3% of all observed cases 2.
- Cervical spine injuries may be occurring in 80% of subjects aged 66.5 years and above 2.
- The most common pattern of cervical spine injury includes:
- Partial or complete disruption of the anterior longitudinal ligament
- Widening of the lower cervical spine disk spaces
- Absence of hyoid-laryngeal fractures
- Anterior longitudinal ligament disruption of the lower cervical spine
- Disk space widening
- No vertebral body displacement 2
- Upper cervical spine injuries are commonly associated with trauma and require significant forces to produce 3.
- Common injuries in the upper cervical spine include:
- Fractures of the cervical spine are potentially serious and devastating if not properly treated 4.
- The axis (C2) is the most commonly fractured vertebra in the upper cervical spine, with odontoid fractures making up 50% of all C2 fractures 5.