A missed traumatic atlanto-axial rotatory subluxation in an adult patient: case report

Traumatic atlanto-axial rotatory subluxation (AARS) in an adult is a rare condition, which if left untreated can be fatal. In addition to this, many symptoms experienced such as neck pain and stiffness are non-specific which often leads to misdiagnosis, thus delaying definitive treatment. AARS can b...

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Bibliographic Details
Published in:Open access emergency medicine 2019-01, Vol.11, p.39-42
Main Authors: Barimani, Bardia, Fairag, Rayan, Abduljabbar, Fahad, Aoude, Ahmed, Santaguida, Carlo, Ouellet, Jean, Weber, Michael
Format: Article
Language:English
Subjects:
Adults
atlanto-axial fixation
atlanto-axial joint
atlanto-axial subluxation
Bone surgery
Case Report
Case reports
Diagnosis
Fractures
Genetic disorders
Injuries
Neck pain
Orthopedic traction
rotatory
torticollis
Trauma
traumatic
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Summary:Traumatic atlanto-axial rotatory subluxation (AARS) in an adult is a rare condition, which if left untreated can be fatal. In addition to this, many symptoms experienced such as neck pain and stiffness are non-specific which often leads to misdiagnosis, thus delaying definitive treatment. AARS can be divided into traumatic and non-traumatic causes with the latter generally encompassing congenital cervical spine abnormalities. We present a case of a 66-year-old female with traumatic rotatory AARS, which was initially misdiagnosed in the emergency department. This patient was subsequently recalled to the hospital when the misdiagnosis was spotted the following day from imaging results. The patient was initially managed conservatively as an inpatient using head halter cervical traction which proved to give good clinical reduction allowing discharge with Miami J upon ambulation. Upon follow up the patient was experiencing continuous pain but remained neurovascularly intact. She thus opted for definitive management with C1-C2 stabilization with an open reduction and internal fixation. This case demonstrates the importance of having a high index of suspicion to diagnose AARS in cervical spine trauma presenting to the emergency department, until exclusion can be made using imaging and clinical examination.
ISSN:1179-1500
1179-1500
DOI:10.2147/OAEM.S149296