Closed reduction of traumatic atlantoaxial rotatory subluxation with type II odontoid fracture

Abstract

Background: Traumatic atlantoaxial rotatory subluxation (TAARS) in adults is rare. We present an uncommon case of traumatic atlantoaxial rotatory subluxation with an associated type II odontoid fracture in a neurologically intact patient and describe a novel technique used for a successful closed reduction. Case description: A 20-year-old female presented with a decreased level of consciousness after being involved in a motor vehicle accident at highway speeds. A computed tomography (CT) demonstrated atlantoaxial rotatory subluxation and a type II odontoid fracture. CT angiography showed a left V3 vertebral dissection. She was neurologically intact on examination. A halo ring was applied and the patient successfully underwent closed reduction using traction and a novel transoral reduction technique described below.After closed reduction, a C1–C2 posterior instrumented fusion was performed. At 12-weeks follow-up, the patient was asymptomatic, neurologically intact with optimally maintained cervical spine alignment. Conclusion: Prompt manual closed reduction can safely be achieved in adults using this novel transoral reduction technique, which we describe for the first time in this report. Keywords: Case report, Traumatic atlantoaxial rotatory subluxation, Closed reduction, Type II odontoid fracture