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Early reoccurrence of traumatic posterior atlantoaxial dislocation without fracture: A case report

Authors
  • Sun, Ying-Hua
  • Wang, Li
  • Ren, Jin-Ting
  • Wang, Su-Xia
  • Jiao, Zhao-De
  • Fang, Jun
Type
Published Article
Journal
World Journal of Clinical Cases
Publisher
Baishideng Publishing Group Inc
Publication Date
Feb 26, 2021
Volume
9
Issue
6
Pages
1461–1468
Identifiers
DOI: 10.12998/wjcc.v9.i6.1461
PMID: 33644216
PMCID: PMC7896674
Source
PubMed Central
Keywords
Disciplines
  • Case Report
License
Green

Abstract

BACKGROUND In general, atlantoaxial dislocation is rare due to the stability of the C1-C2 complex. Traumatic atlantoaxial dislocations are usually anterior and accompanied by odontoid fractures. Posterior atlantoaxial dislocations are rare, and complete posterior dislocation without associated fracture is even more rare. A case of early recurrence of posterior atlantoaxial dislocation without fracture being in therapy of first closed reduction and then open reduction has not been previously reported. CASE SUMMARY A 45-year-old female presented with traumatic posterior atlantoaxial dislocation (TPAD) of C1-C2 without associated fractures, and Frankel Grade B spinal cord function. She was successfully managed by immediate closed reduction under skull traction. Unexpectedly, 17 d later, re-dislocation was discovered. On day 28, closed reduction was performed as before but failed. Then, open reduction and posterior internal fixation with autologous iliac bone grafts was performed. By 6 mo after surgery, atlantoaxial joint fusion was achieved, and neurological function had recovered to Frankel Grade E. At 12 mo follow-up, she had lost only 15° of cervical rotation, and atlantoaxial complex instability in joint flexing and extending were no longer observed under fluoroscopy. CONCLUSION Early assessment of transverse ligament is critical for TPAD without fracture avoiding re-dislocation after closed reduction.

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