Atlantoaxial Rotatory Displacement

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Background

• A common cause of childhood torticullis
• Subluxation/dislocation injury at C1-2 that has been reported to occur after a Clavicle Fracture
• The C1 vertebral body is rotated in relation to the C2 vertebral body

Epidemiology

• Most commonly seen ages 6-10 (need citation)

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Pathophysiology

Etiology

• Infection (most common, need citation)
• Sternocleidomastoid muscle spasm
• Neoplasm
• Medication side effect

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Clinical Features

• The head will tilt towards the side of clavicle injury

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Evaluation

• Radiographs
  • Standard views
  • Difficult to see and often missed initially
  • Consider flexion-extension films
• CT
  • Helpful to better evaluate subluxation or dislocation

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Management

Nonoperative

• Upon initial diagnosis, place is soft cervical spine collar
• Consult pediatric spine surgeon
• Patients can often be successfully managed nonoperatively
  • Soft cervical collar
  • Head halter traction
• May spontaneously reduce

Operative

• Delayed diagnosis more likely to require surgical intervention
• Technique
  • C1-C2 Fusion

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See Also

• External
  • Sports Medicine Review Neck Pain: https://www.sportsmedreview.com/by-joint/neck/

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