Abstract
Introduction
Atlantoaxial rotatory fixation (AARF) is also known as rotatory subluxation, rotatory displacement, rotary deformity, rotational subluxation, and is characterized by incomplete dislocation of the inferior atlantal and superior axial articular facets.1 AARF in combination with odontoid fracture is an extremely rare injury.2–6 Atlantoaxial injuries can be classified according to Fielding 1 or White and Panjabi7 classification. The management of this combination is a matter of debate. 1,8,9
Material and Methods
We present a case of a 78 years old woman who sustained a fall on the ground from a couch directly on her forehead, resulting in atlantoaxial dislocation with type II odontoid fracture accompanied with left sided hemiparesis ASIA type C.
Results
After failure of closed reduction, the treatment plane was to achieve reduction under anesthesia and C1–2 fusion, but again reduction was not possible. Occipitocervical fusion to C3 was done to have better stability in osteoporotic bone. Successful reduction was achieved during rod reduction from the occiput to C2 pedicle screw and C3 lateral mass screw. Cervical collar was advised for 3 months, and good fusion and improvement of the neurological status to ASIA type D was achieved after 6 month.
Conclusion
AARF with Odontoid Fracture is a rare combination and reduction may be impossible. Occipitocervical fusion is a good option in such case as C1–2 reduction is a prerequisite for transarticular screw. C2 pedicle screw offers good purchase even in osteoporotic bone which enabled reduction after rod repositioning.
Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 1977;59(1):37–44
Born CT, Mure AJ, Iannacone WM, DeLong WG Jr. Three-dimensional computerized tomographic demonstration of bilateral atlantoaxial rotatory dislocation in an adult: report of a case and review of the literature. J Orthop Trauma 1994;8(1):67–72
Jones RN. Rotatory dislocation of both atlanto-axial joints. J Bone Joint Surg Br 1984;66(1):6–7
Moore KR, Frank EH. Traumatic atlantoaxial rotatory subluxation and dislocation. Spine 1995;20(17):1928–1930
Robertson PA, Swan HA. Traumatic bilateral rotatory facet dislocation of the atlas on the axis. Spine 1992;17(10):1252–1254
Wise JJ, Cheney R, Fischgrund J. Traumatic bilateral rotatory dislocation of the atlanto-axial joints: a case report and review of the literature. J Spinal Disord 1997;10(5):451–453
White AA III, Panjabi MM. The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am 1978;9(4):867–878
Schmidek HH, Smith DA, Sofferman RA, Gomes FB. Transoral unilateral facetectomy in the management of unilateral anterior rotatory atlantoaxial fracture/dislocation: a case report. Neurosurgery 1986;18(5):645–652
Crockard HA, Rogers MA. Open reduction of traumatic atlanto-axial rotatory dislocation with use of the extreme lateral approach. A report of two cases. J Bone Joint Surg Am 1996;78(3):431–436