Closed reduction in the emergency room following traumatic C1-C2 rotary subluxation: a paediatric perspective

Atlantoaxial rotatory subluxation (AARS) represents a significant cause of acute torticollis in children involving rotational displacement of C1 on C2. Unlike common idiopathic torticollis, AARS represents a true subluxation that frequently necessitates reduction by an experienced provider to restore alignment. Here, we present the case of a child who developed AARS after falling out of bed. A CT scan confirmed acute C1-C2 rotatory subluxation. The patient was successfully treated with closed reduction under sedation in the emergency department by a paediatric spine surgeon, followed by immobilisation in a cervical collar. At the 2-week follow-up, she had achieved a full clinical and radiographic recovery with a return to normal function. This case underscores the necessity of maintaining a high index of suspicion for AARS in traumatic paediatric torticollis, highlights the role of advanced imaging in reaching a definitive diagnosis and confirms that non-operative management can lead to excellent outcomes.