Traumatic pediatric atlantoaxial rotatory dislocation successfully reduced with 1 month total of halter traction: a case report
The occurrence of atlantoaxial rotatory subluxation is fairly uncommon; however, it is more common to be encountered in the paediatric population, typically seen after a retropharyngeal inflammation or after a minor trauma. Ligamentous laxity, shallower and more horizontally oriented facet joints...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Kulliyyah of Medicine, International Islamic University Malaysia
2017
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| Online Access: | http://irep.iium.edu.my/64038/ http://irep.iium.edu.my/64038/ http://irep.iium.edu.my/64038/1/64038_TRAUMATIC%20PEDIATRIC%20ATLANTOAXIAL.pdf |
| Summary: | The occurrence of atlantoaxial rotatory subluxation is fairly uncommon; however, it is
more common to be encountered in the paediatric population, typically seen after a
retropharyngeal inflammation or after a minor trauma. Ligamentous laxity, shallower
and more horizontally oriented facet joints especially at the C1-2 joint making them
prone to have atlantoaxial subluxation or dislocation. If recognized early it can be
successfully managed non-surgically before chronic inflammatory changes affect the
ligaments and joint structure of the C1-2 complex. However, there is no standard
treatment protocol as some authors like Nael et al and Haliasos and Norris recommended
more invasive Halo skull traction. Thus, we report this case managed with less invasive
Halter traction with no risk of pin site infections. We present the case of a 12-year-old
Malay boy with traumatic atlantoaxial dislocation who came to us after he slipped and
fell, presented with neck pain and torticollis to the left side but without other
neurological deficits. A computed-tomography (CT) scan revealed an atlantoaxial
rotation of 47 to the left without any signs of osseous lesions. MRI was also done and all
ligaments were intact. The neck was then reduced by cautious rotation with Halter
traction with the cervical spine in the neutral position with slight flexion thus avoiding
harm by potential posttraumatic disc lesions. The patient was put on Halter traction for
a total of one month. Post-traction revealed full range of motion of the neck without
any tenderness, head and neck alignment restored to neutral position. In the children
population, atlantoaxial subluxation is a rare condition but is severe if left untreated.
Early treatment implies a non-surgical approach and a good outcome is observed in our
case as well as reported by other authors. |
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