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Atlantoaxial rotary subluxation in children
1Department of Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA. aemuniz@aol.com
Insights
Atlantoaxial rotary subluxation is an uncommon cause of traumatic torticollis in children presenting to the emergency department. Prompt recognition and management are key for effective treatment.
Area of Science:
- Pediatric Emergency Medicine
- Orthopedic Surgery
- Radiology
Background:
- Traumatic torticollis is an infrequent emergency department (ED) presentation.
- Atlantoaxial rotary subluxation is a significant cause in pediatric patients.
- This condition often follows minor trauma and presents with characteristic neck pain and limited motion.
Observation:
- Patients typically exhibit a "cock-robin" head position.
- Clinical evaluation is crucial for differential diagnosis.
- Radiographic imaging, including CT scans, is essential for confirming odontoid and atlas asymmetry.
Findings:
- The study highlights two pediatric cases of atlantoaxial rotary subluxation.
- Diagnostic challenges in the ED setting are addressed.
- Management strategies are presented based on case severity.
Implications:
- Early diagnosis and appropriate management of atlantoaxial rotary subluxation are vital.
- Treatment options range from conservative measures like cervical collars to surgical interventions.
- This underscores the importance of considering subtle spinal injuries in pediatric torticollis evaluations.
Abstract:
Traumatic torticollis is an uncommon complaint in the emergency department (ED). One important cause in children is atlantoaxial rotary subluxation. Most children present with pain, torticollis ("cock-robin" position), and diminished range of motion. The onset is spontaneous and usually occurs following minor trauma. A thorough history and physical examination will eliminate the various causes of torticollis. Radiographic evaluation will demonstrate persistent asymmetry of the odontoid in its relationship to the atlas. Computed tomography, especially a dynamic study, may be needed to verify the subluxation. Treatment varies with severity and duration of the abnormality. For minor and acute cases, a soft cervical collar, rest, and analgesics may be sufficient. For more severe cases, the child may be placed on head halter traction, and for long-standing cases, halo traction or even surgical interventions may be indicated. We describe two patients with atlantoaxial rotary subluxation, who presented with torticollis, to illustrate recognition and management in the ED.