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      Traumatic atlantoaxial rotatory subluxation in an adolescent: a case report

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          Abstract

          Introduction

          Atlantoaxial rotatory subluxation is rarely caused by trauma in adults. Usually, the treatment of choice is traction using Halo/Gardner-Wells fixation devices for up to six weeks.

          Case presentation

          We present the case of a 19-year-old Caucasian woman with traumatic atlantoaxial subluxation. Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good clinical results.

          Conclusion

          In the adult population, atlantoaxial subluxation is a rare condition but is severe if untreated. Early treatment implies a non-surgical approach and a good outcome. Conservative treatment is the recommended first step for this condition.

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          Most cited references17

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          Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint).

          Alastair R. Hawkins, Alistair Fielding (1976)
          In seventeen cases of irreducible atlanto-axial rotatory subluxation (here called fixation), the striking features were the delay in diagnosis and the persistent clinical and roentgenographic deformities. All patients had torticollis and restricted, often painful neck motion, and seven young patients with long-standing deformity had flattening on one side of the face. The diagnosis was suggested by the plain roentgenograms and tomograms and confirmed by persistence of the deformity as demonstrated by cineroentgenography. Treatment included skull traction, followed by atlanto-axial arthrodesis if necessary. Of the thirteen patients treated by atlanto-axial arthrodesis, eleven had good results, one had a fair result, and one had not been followed for long enough to determine the result. Of the remaining four patients, one treated conservatively had not been followed for long enough to evaluate the result, two declined surgery, and one died while in traction as the result of cord transection produced by further rotation of the atlas on the axis despite the traction.
          Article 0 comments Cited 74 times – based on 0 reviews     Review now
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            Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint)

            JW Fielding, RJ Hawkins (1977)
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              The management of rotatory atlanto-axial subluxation in children.

              Richard A. Phillips, R Hensinger (1989)
              Twenty-three children who were treated for rotatory atlanto-axial subluxation between 1975 and 1986 were retrospectively studied. The success of closed reduction with traction and the length of hospitalization were related to the duration of symptoms before admission. In sixteen of the children, who were seen less than a month after the onset of symptoms, the subluxation reduced either spontaneously or after a short period of traction. Of the seven remaining children, who were seen more than one month after the onset of symptoms, three eventually needed a posterior atlanto-axial arthrodesis. Dynamic computed-tomography scans, with the head rotated maximally to each side, were made for five children, and proved to be an excellent method of documenting the presence of rotatory atlanto-axial subluxation.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Med Case Reports
                Title: Journal of Medical Case Reports
                Publisher: BioMed Central
                ISSN (Electronic): 1752-1947
                Publication date Collection: 2012
                Publication date (Electronic): 23 January 2012
                Volume: 6
                Page: 27
                Affiliations
                [1 ]Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
                Article
                Publisher ID: 1752-1947-6-27
                DOI: 10.1186/1752-1947-6-27
                PMC ID: 3275470
                PubMed ID: 22269577
                SO-VID: b63b4c1b-ef9e-412f-a407-a282fded838d
                Copyright © Copyright ©2012 Meza Escobar et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 August 2011
                Date accepted : 23 January 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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