Traumatic Pediatric Atlantoaxial Rotatory Subluxation Successfully Reduced and Discharged from the Emergency Department: A Case Report

The incidence of atlantoaxial rotatory subluxation is fairly uncommon; however it is more common to be encountered in the pediatric population. It is usually seen in children after a retropharyngeal inflammation or after a minor trauma. Children have unique anatomical features such as inherent ligamentous laxity and shallower and more horizontally oriented facet joints that allow greater freedom of motion especially at the C1-2 joint making them prone to atlantoaxial subluxation. If recognized early it can be successfully managed nonsurgically before chronic inflammatory changes affect the ligaments and joint structure of the C1-2 complex. However, it is unclear in the literature if inpatient admission is necessary for treatment. Here we present a case of atlantoaxial rotatory subluxation in a child caused by forcefully throwing a ball that was successfully reduced and subsequently discharge from the pediatric emergency department all in the same visit.