Hangman's fracture: a historical and biomechanical perspective

Historical vignette

Mahmoud Rayes Department of Neurosurgery, Wayne State University, Detroit, Michigan

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Monika Mittal Department of Neurosurgery, Wayne State University, Detroit, Michigan

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Setti S. Rengachary Department of Neurosurgery, Wayne State University, Detroit, Michigan

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Sandeep Mittal Department of Neurosurgery, Wayne State University, Detroit, Michigan

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The execution technique of hanging, introduced by the Angle, Saxon, and Jute Germanic tribes during their invasions of the Roman Empire and Britain in the 5th century, has remained largely unchanged over time. The earliest form of a gallows was a tree on which prisoners were hanged. Despite the introduction of several modifications such as a trap door, the main mechanism of death remained asphyxiation. This created the opportunity for attempted revival after the execution, and indeed several well-known cases of survival following judicial hanging have been reported. It was not until the introduction of the standard drop by Dr. Samuel Haughton in 1866, and the so-called long drop by William Marwood in 1872 that hanging became a standard, humane means to achieve instantaneous death. Hangmen, however, fearing knot slippage, started substituting the subaural knot for the traditional submental knot. Subaural knots were not as effective, and cases of decapitation were recorded. Standardization of the long drop was further propagated by John Berry, an executioner who used mathematical calculations to estimate the correct drop length for each individual to be hanged. A British committee on capital sentences, led by Lord Aberdare, studied the execution method, and advocated for the submental knot. However, it was not until Frederic Wood-Jones published his seminal work in 1913 that cervical fractures were identified as the main mechanism of death following hanging in which the long drop and a submental knot were used. Schneider introduced the term “hangman's fracture” in 1965, and reported on the biomechanics and other similarities of the cervical fractures seen following judicial hangings and those caused by motor vehicle accidents.

Abbreviation used in this paper:

cwt = centrum weight.
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  • 1

    Colice GL, Historical background. Tobin MJ: Principles and Practice of Mechanical Ventilation New York, McGraw-Hill, 1994. 135

  • 2

    Cornish BL: Traumatic spondylolisthesis of the axis. J Bone Joint Surg Br 50:3143, 1968

  • 3

    de Zouche Marshall JJ: Judicial executions. BMJ 2:779786, 1888

  • 4

    de Zouche Marshall JJ: Judicial hanging. Lancet 1:194, 1913. (Letter)

  • 5

    Duff C: A New Handbook on Hanging London, Andrew Melrose Ltd, 1954

  • 6

    Effendi B, , Roy D, , Cornish B, , Dussault RG, & Laurin CA: Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br 63-B:319327, 1981

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Francis WR, , Fielding JW, , Hawkins RJ, , Pepin J, & Hensinger R: Traumatic spondylolisthesis of the axis. J Bone Joint Surg Br 63-B:313318, 1981

  • 8

    Garber JN: Abnormalities of the atlas and axis vertebrae—congenital and traumatic. J Bone Joint Surg Am 46:17821791, 1964

  • 9

    Grogono BJS: Injuries of the atlas and axis. J Bone Joint Surg Br 36:397410, 1954

  • 10

    Hammond GM: On the proper method of executing the sentence of death by hanging. Med Rec 22:426428, 1882

  • 11

    Haughton S: On hanging, considered from a mechanical and physiological point of view. London Edinburgh Dublin Philosophical Magazine and Journal of Science 32:2334, 1866

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Jones FW: The examination of the bodies of 100 men executed in Nubia in Roman times. BMJ 1:736737, 1908

  • 13

    Levine AM, Traumatic spondylolisthesis of the axis (Hangman's fracture). Levine AM, , Eismont FJ, & Garfin SR, et al.: Spine Trauma Philadelphia, WB Saunders, 1998. 278299

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Levine AM, & Edwards CC: The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 67:217226, 1985

  • 15

    Levine AM, & Rhyne AL: Traumatic spondylolisthesis of the axis. Semin Spine Surg 3:4760, 1991

  • 16

    Li XF, , Dai LY, , Lu H, & Chen XD: A systematic review of the management of hangman's fractures. Eur Spine J 15:257269, 2006

  • 17

    Molnár Z: Thomas Willis (1621–1675), the founder of clinical neuroscience. Nat Rev Neurosci 5:329335, 2004

  • 18

    Paterson AM: Fracture of the cervical vertebrae. J Anat Phys 24:ix, 1890

  • 19

    Pepin JW, & Hawkins RJ: Traumatic spondylolisthesis of the axis: Hangman's fracture. Clin Orthop Relat Res 157 133138, 1981

  • 20

    Pryputniewicz DM, & Hadley MN: Axis fractures. Neurosurgery 66:3 Suppl 6882, 2010

  • 21

    Rengachary SS, , Xavier A, , Manjila S, , Smerdon U, , Parker B, & Hadwan S, et al.: The legendary contributions of Thomas Willis (1621–1675): the arterial circle and beyond. Historical vignette. J Neurosurg 109:765775, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Robertson WGA: Recovery after judicial hanging. BMJ 1:121122, 1935

  • 23

    Schneider RC, , Livingston KE, , Cave AJ, & Hamilton G: “Hangman's fracture” of the cervical spine. J Neurosurg 22:141154, 1965

  • 24

    Vermooten V: A study of the fracture of the epistropheus due to hanging with a note on the possible causes of death. Anat Rec 20:305311, 1921

  • 25

    Wolff R: Injury to the cervical vertebrae as a result of judicial hanging. Journal of Medical Association of South Africa 2:460462, 1928

  • 26

    Wood-Jones F: The ideal lesion produced by judicial hanging. Lancet 1:53, 1913

  • 27

    Zsolczai S, & Pentelényi T: The modern approach of hangman's fracture. Acta Chir Hung 31:324, 1990

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