A condemned prisoner is executed by judicial hanging using a long drop. Which anatomical level shows the classical fatal injury responsible for instantaneous death?

• A Fracture of the odontoid process of C1
• B Dislocation at the C7-T1 junction
• C Compression fracture of C5-C6
• D Fracture-dislocation at the C2-C3 level ✓

Explanation

The long drop in judicial hanging produces fracture-dislocation at the C2-C3 level, typically involving the pedicles of C2 (hangman-type injury), with transection or crushing of the spinal cord and medullary concussion causing instant unconsciousness and death. Upper levels such as C1 are rarely involved because the drop forces hyperextension with distraction at the mid-cervical region. Lower cervical injuries occur in short-drop accidental hanging where cord damage is minimal.

Reference: Modi's Medical Jurisprudence and Toxicology, 23rd ed.

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Written and medically reviewed by the StethoPrep medical team.