Traumatic Pediatric Atlantoaxial Rotatory Subluxation Successfully Reduced and Discharged from the Emergency Department: A Case Report

Abstract

The incidence of atlantoaxial rotatory subluxation is fairly uncommon; however it is more common to be encountered in the pediatric population. It is usually seen in children after a retropharyngeal inflammation or after a minor trauma. Children have unique anatomical features such as inherent ligamentous laxity and shallower and more horizontally oriented facet joints that allow greater freedom of motion especially at the C1-2 joint making them prone to atlantoaxial subluxation. If recognized early it can be successfully managed nonsurgically before chronic inflammatory changes affect the ligaments and joint structure of the C1-2 complex. However, it is unclear in the literature if inpatient admission is necessary for treatment. Here we present a case of atlantoaxial rotatory subluxation in a child caused by forcefully throwing a ball that was successfully reduced and subsequently discharge from the pediatric emergency department all in the same visit. There is no clear criterion for inpatient admission of pediatric atlantoaxial rotatory subluxation. We present a unique case of atlantoaxial rotatory subluxation in a child after the benign act of throwing a ball that was successfully treated and discharged home from the emergency department in the same visit with close outpatient follow up.