title: Post-traumatic atlantoaxial rotatory fixation in an adult: a case report.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  To describe an interesting patient who underwent open reduction and C1-C2 transpedicular screw fixation with interspinous wiring due to high-riding vertebral artery.
  
  
  BACKGROUND
  Atlantoaxial rotatory fixation (AARF) is a rare complication found most frequently after trauma in children and young adults; the clinical diagnosis is difficult and often made late.
  
  
  METHODS
  We report a case of post-traumatic AARF associated with a facet fracture in an adult. Reduction proved difficult to obtain by skull traction and gentle manipulation. Therefore, after open reduction under general anesthesia, we performed C1-C2 transpedicular screw fixation with posterior wiring to avoid vertebral artery injury due to high-riding transverse foramen at the C2 vertebra.
  
  
  RESULTS
  The normal atlantoaxial relation was restored and the torticollis resolved. The patient remains neurologically intact and has radiographic documentation of fusion.
  
  
  CONCLUSIONS
  Although technically demanding, C1-C2 transpedicular screw fixation combined with interspinous bone graft wiring after open reduction may be an alternative treatment option if conservative treatment fails to reduce AARF.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Yeon-Seong
authors.initials: YS
authors.lastname: Kim
authors.forename: Jung-Kil
authors.initials: JK
authors.lastname: Lee
authors.forename: Sung-Jun
authors.initials: SJ
authors.lastname: Moon
authors.forename: Soo-Han
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000058:Accidental Falls; D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000293:injuries*; D001863:Bone Screws; D016025:Bone Transplantation; D001864:Bone Wires; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D005596:Fractures, Closed / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D015641:Radiography, Interventional; D012399:Rotation; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000209:etiology / Q000601:surgery*; D014711:Vertebral Artery / Q000000981:diagnostic imaging