Traumatic atlantoaxial rotatory dislocation with odontoid fracture - Case report and review

Study Design. A case of traumatic rotatory dislocation associated with odontoid fracture is reported. Objectives. To report a rare case of traumatic rotatory dislocation associated with odontoid fracture, and to discuss the mechanism underlying spinal instability and management. Summary of Background Data. This case is a cross between traumatic rotatory fixation and atlantoaxial rotatory dislocation. Classification of rotatory subluxation change after osteosynthesis of the odontoid process was undertaken. Methods. A 24-year-old man sustained head and cervical injury after jumping. A Type 2 odontoid fracture without displacement was noted. Results. Without further traumatic event, 1 month after injury, computed tomography scan showed posterior displacement of the odontoid fracture and Type 4 or a atlantoaxial rotatory luxation. After surgical fixation and reduction of the odontoid fracture, the rotatory subluxation classification changed and became Type 1 or A. Posterior C1-C2 arthrodesis was performed. The patient wore a Philadelphia cervical collar for 3 months and underwent physiotherapy. Conclusions. As the pivot of rotatory subluxation changed after odontoid process osteosynthesis, posterior C1-C2 arthrodesis was performed. The patient probably could have been treated in a single-stage procedure using posterior C1-C2 transarticular fixation with bicortical interspinous graft.