[Traumatic atlanto-axial rotatory fixation with lateral mass fracture of the axis]

Traumatic atlanto-axial rotatory fixation (AARF) is a relatively uncommon injury, especially in association with fractures of the axis. The rotatory dislocation and fixation is normally caused by intercalated facet joints of axis and atlas. A traumatic AARF in a 21 year old female is presented with special emphasis on the diagnostic and therapeutic approaches. This high velocity injury was caused by a traffic accident. The trauma service which was initially involved made the correct diagnosis and tried to reduce the dislocation by skull traction during analgesia and sedation, but without success. For further treatment, the patient was referred to a level one trauma center. After completing the diagnostic imaging with MRI and CT for exact delineation of the fracture site and determination of ligament damage, a halo fixation for skull traction was installed. This second attempt was also unsuccessful. Only a closed reduction under general anesthesia with muscle relaxation led to a neutral alignment and congruent joint contact between C1 and C2. Due to the stable fracture site and the intact ligaments, a conservative treatment with a stable collar splint was performed.