Traumatic atlantoaxial rotatory fixation associated with C2 articular facet fracture in adult patient: Case report

Abstract

Traumatic atlantoaxial rotatory fixation is a very rare injury in adults which is often misdiagnosed initially. Its combination with C2 fractures is predominated by dens lesions. Therapeutic management is challenging because of the difficulty to achieve optimal reduction and permanent stability. We report a rare case of traumatic atlantoaxial rotatory fixation in a 56-year-old women associated with C2 articular facet fracture successfully treated by conservative means after patient-awake manual reduction with optimal functional and radiographic outcome.

Rotation of the second cervical vertebra in pediatric patient

“…(1-5) This prevalence occurs because of specific anatomic characteristics of childhood, such as disproportion between head-neck, underdeveloped cervical musculature, laxity of the joint capsule, ligament elasticity and horizontal shape of the articular facets between atlas and axis vertebrae. (3-7) This condition can occur due to inflammation/infection (2,6,7) or trauma, (1,2,4,6) or because of neurogenic or idiopathic origin. (2) …”

“…(7,8) Among imaging exams of bone tissue, radiographies in anteroposterior and lateral projections are of limited use because they do not enable a precise visualization of this alteration, due to difficulties in positioning patients (head offset or source of X-rays, and overlap of structures), leading to radiographic interpretation challenges. (1,6,7) Computed tomography is considered the gold standard procedure. (1,6,7) Images of tridimensional reconstruction provides a global visualization of rotation, therefore helping to establish the diagnosis.…”

“…(1,6,7) Computed tomography is considered the gold standard procedure. (1,6,7) Images of tridimensional reconstruction provides a global visualization of rotation, therefore helping to establish the diagnosis. (2,3,7) In addition, the magnetic resonance image can also be requested to evaluate the risk of vascular-nervous bundle compromising and injuries of the ligaments adjacent to vertebrae.…”

“…(2,3,7) In addition, the magnetic resonance image can also be requested to evaluate the risk of vascular-nervous bundle compromising and injuries of the ligaments adjacent to vertebrae. (1,5-7) …”

“…Treatment can be conservative using immobilization, (3-5,7,9) traction or manual reduction, (3,4,7,9) with the use of analgesic, (3) physiotherapy (1,9) or surgery. (3,7,9) …”