Adult Traumatic Atlantoaxial Rotatory Fixation: A Case Report

We presented a very rare case of adult Fielding type I atlantoaxial rotatory fixation (AARF). We performed awake manual reduction of the dislocation without need for anesthesia, achieving excellent outcomes, and no previous reports have described awake reduction without the need for anesthesia. AARF in this case was attributed to excessive extension and rotation forces applied to the cervical spine. For the management of adult Fielding type I AARF, early diagnosis and early reduction may lead to excellent outcomes. 1. Introduction We treated a very rare adult traumatic atlantoaxial rotatory fixation (AARF) with manual reduction while patient was awake, obtaining excellent outcomes. This case is reported together with a discussion of characteristics in adult cases. 2. Case Report The patient was a 22-year-old man. While driving, he steered in the wrong direction at an intersection and collided with an oncoming car. After complaining of intense cervical pain, he was brought by ambulance to our emergency outpatient unit. He had no previous history of note. On initial consultation, the patient could not move his head at all from its position facing to the right (Figure 1(a)). He had clear consciousness and no motor paralysis or sensory disturbance. A lacerated wound (Figure 1(b)), about 1？cm in length, was observed over the right inferior mandible. Computed tomography (Figure 2) revealed that the atlas was rotated to the right centering on the dens of the axis. However, no findings suggested congenital dysplasia, and no fractures such as the articular process were observed. Based on a three-dimensional CT (Figure 3), we diagnosed AARF of Fielding classification type I [1] without a protruding eccentric jaw position. Figure 1: The patient could not move his head at all from its position facing to the right (a). A lacerated wound over the right inferior mandible (b). Figure 2: Computed tomography revealed that the atlas was rotated to the right centering on the dens of the axis. (a) Axial view of atlas and (b) axial view of axis. Figure 3: The three-dimensional CT showed atlantoaxial rotatory fixation of Fielding classification type I. (a) Posterior view and (b) anterior view. Treatment comprised manual reduction while patient was awake about 2 hours after injury. At first, we held the mandible, providing traction in the cephalic direction, confirming that the patient did not develop pain or palsy in the upper extremities, and rotated it slowly to the left to obtain a feeling of reduction. Immediately after reduction, cervical pain was alleviated and no