Surgical Treatment of Irreducible AcuteTraumatic Atlantoaxial Rotatory Subluxation in an Adult

Traumatic atlantoaxial rotatory subluxation (AARS) is a condition that is extremely rare in adults when compared to the pediatric population. The most common symptoms of this condition are torticollis and post-traumatic neck pain. Our patient is a 41-year-old male who presented to the emergency room within hours of the injury. He came by himself with his relative as a case of road traffic accident. He was the first passenger and had been restrained during the car accident, with no ejection or rollover. He presented with stiffness/pain and reduced range of motion in the neck. Computed tomography (CT) of the cervical spine showed rotatory subluxation of C1 over the C2 with a locked facet. Within 24 hours of the RTA and patient admission, we attempted cervical traction. The reduction was not successful. So, we decided to reduce AARS through a surgical approach. The patient was taken to the operating room for open reduction and fixation using the Harms technique for C1-C2 fusion. The patient recovered from the surgery uneventfully, without any complications, recovered cervical mobility, and improved torticollis. Surgical management through open reduction and internal fixation is recommended for AARD cases in which close reduction fails due to a locked facet.