Staged Management of Adult Traumatic Atlantoaxial Rotatory Fixation With C2 Superior Facet Fracture: A Case Report

Atlantoaxial rotatory fixation (AARF) is a rare pathological condition predominantly seen in pediatric populations. In adults, particularly when accompanied by C2 facet fractures, it poses unique diagnostic and therapeutic challenges. While conservative treatment may be effective in select cases, the presence of mechanical and/or ligamentous instability often necessitates surgical intervention. We report the case of a 73-year-old male who sustained traumatic AARF with an associated fracture of the right C2 superior articular facet following a bicycle collision. Initial conservative management, including bed rest and analgesia, failed to achieve a reduction. On post-injury day five, closed reduction was performed under general anesthesia and followed by halo vest immobilization. Imaging post-reduction revealed potential instability at the fracture site and a suspected transverse ligament injury. Surgical stabilization via posterior C1-C2 fixation using the Goel-Harms technique was undertaken on day nine. The postoperative course was uneventful, and the patient was discharged on day 52. At the one-year follow-up, alignment was maintained with substantial improvements in pain and neck function. No recurrence of rotational deformity was noted, although complete osseous union of the facet fracture was not achieved. This case illustrates that staged management combining closed reduction and posterior fixation can be effective for complex adult AARF with concurrent facet fractures. Early surgical intervention should be considered in the presence of instability or when conservative measures fail. Individualized treatment planning, informed by anatomical and biomechanical considerations, is critical for optimal outcomes.