Torticollis of a specific C1 dislocation with split atlas.
METHODS
A case report.


OBJECTIVE
We report a novel case of torticollis disorder because of a congenital split atlas after minor trauma.


BACKGROUND
Torticollis experienced after minor trauma in childhood is usually because of atlantoaxial rotatory fixation, which is a common disorder in pediatric patients and is usually diagnosed with computed tomography (CT). CT scanning with 3-dimensional reconstruction, however, showed a unique rotation of split atlas, a congenital anomaly that presented with torticollis.


METHODS
A female child aged 3 years and 11 months presented to the orthopedic clinic with torticollis after a fall. CT imaging showed no rotatory dislocation of C1-C2. On the 3-dimensional CT reconstruction images, however, anterior and posterior defects in the atlas, the so-called split atlas, and an atypical rotation with malalignment of the posterior arch and asymmetry of the atlantoaxial facet joint were noted. The child was treated with closed reduction using skull traction under general anesthesia.


RESULTS
Repositioning of the atlas rotation was confirmed using intraoperative 3-dimensional scanning, and open reduction therapy was avoided. The patient was treated with halo vest for 8 weeks and had full recovery of neck motion with resolution of the torticollis.


CONCLUSIONS
We present a novel torticollis disorder caused by C1 rotation of a split atlas with closed reduction treatment.
Tachibana
Atsuko
A
Department of Orthopedics, National Defense Medical College, Saitama, Japan. hotchild53@hotmail.co.jp
Imabayashi
Hideaki
H
Yato
Yoshiyuki
Y
Nakamichi
Kiyohiro
K
Asazuma
Takashi
T
Nemoto
Koichi
K
D001268:Atlanto-Axial Joint / Q000293:injuries*; D001270:Cervical Atlas; D002675:Child, Preschool; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications* / Q000175:diagnosis; D019637:Orthopedic Procedures / Q000379:methods; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome