title: Traumatic atlantoaxial rotatory dislocation and displaced ossiculum terminale epiphysiolysis treated with a halo device: a case report.
abstract: BACKGROUND
  The horizontal synchondroses of the infant axis are biomechanical weak regions in trauma.
  
  
  METHODS
  We report the case of a 6-year-old girl who presented with delayed atlantoaxial dislocation and displaced ossiculum terminale epiphysiolysis after a fall from a tree.
  
  
  METHODS
  The patient was treated with halo traction for 3 days after which a CT scan showed normal position of the C1/C2 joint, and an acceptable position of the ossiculum terminale whereafter a halo brace was applied. Because of delayed union on CT scans, the treatment was prolonged to a total of 21 weeks.
  
  
  RESULTS
  At final follow-up 26 months after halo brace removal, the patient demonstrated normal range of movement of the neck on clinical examination and radiographs of the cervical spine including lateral flexion/extension radiographs showed no sign of instability of the atlantoaxial joint.
  
  
  CONCLUSIONS
  Conservative treatment with a halo device versus surgical treatment is discussed.
authors.affiliation: Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Copenhagen University Hospital, Nordre Ringvej 57, 2600, Glostrup, Denmark. jwalbom@gmail.com.
authors.forename: Jonas
authors.initials: J
authors.lastname: Walbom
authors.affiliation: Department of Orthopaedic Surgery, Spine Unit, Rigshospitalet-Blegdamsvej, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Kruse
mesh_terms: D001268:Atlanto-Axial Joint / Q000293:injuries* / Q000473:pathology; D002648:Child; D004839:Epiphyses, Slipped / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery; D016910:Orthodontic Brackets; D014057:Tomography, X-Ray Computed
keywords: Atlantoaxial rotatory dislocation; Halo brace; Ossiculum terminale; Synchondrosis
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