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Current clinical characteristics and Management of Pediatric Traumatic Atlantoaxial Rotatory Subluxation: An American
Maximilian Peter Forssten1, Ioannis Ioannidis, Sebastian Peter Forssten
1From the Department of Orthopedic Surgery (M.P.F., I.I., S.P.F.), Orebro University Hospital, Orebro, Sweden; School of Medical Sciences (M.P.F., I.I., A.M.I., S.M.), Orebro University, Orebro, Sweden; Department of Orthopedic Surgery (A.M.I.), Vastmanland Hospital Vasteras, Vasteras, Sweden; Clinical Epidemiology and Biostatistics (Y.C.), School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden; and Center of Trauma and Critical Care (B.S.), George Washington University, Washington, DC.
Background:
Atlantoaxial rotatory subluxation (AARS) is an important differential diagnosis in pediatric patients presenting with torticollis, which is caused by the subluxation of the C1 vertebra relative to the C2 vertebra. Because of the uncommon nature of this condition, there is a paucity in sufficiently sized studies describing AARS. The aim of the current investigation was therefore to characterize current clinical characteristics and management of AARS.
Methods:
The American College of Surgeons Trauma Quality Improvement Program database from 2016 to 2021 was queried for pediatric (17 years old or younger) patients who were diagnosed with AARS following blunt trauma. Patients were grouped by age in order to describe and compare demographics, clinical characteristics, and in-hospital outcomes. A subgroup analysis was also performed on patients with isolated AARS, defined as AARS without the presence of a cervical fracture and an Abbreviated Injury Scale score of ≤1 in all regions besides the spine.
Results:
A total of 469 cases of AARS were identified, 211 (45.0%) were isolated AARS. Of these patients, 56.3% of AARS patients and 64.5% of isolated AARS patients were 8 years old or younger. Atlantoaxial rotatory subluxation in adolescents was due to a motor vehicle collision in 60.0% of cases, while 52.5% of infants/toddlers were injured in falls. Of all patients with AARS, 87.4% were managed conservatively, with or without a brace/other immobilizing device, while surgery was only indicated in 9.3% of patients. In cases of isolated AARS, conservative treatment was even more prevalent, with 92.4% of patients managed conservatively and only 4.7% requiring surgical intervention.
Conclusion:
Atlantoaxial rotatory subluxation is most common in children 8 years old and younger, with the majority of cases resulting from falls or motor vehicle accidents. In the Trauma Quality Improvement Program database, most cases were able to be managed conservatively without the need for surgical intervention.
Level Of Evidence:
Therapeutic/Care Management; Level IV.
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