title: Atlantoaxial Rotatory Subluxation in Children.
abstract: OBJECTIVE
  Pediatric cervical injuries are uncommon. This study was to describe injury circumstances, clinical findings, and management among children diagnosed with atlantoaxial rotatory subluxation (AARS) to aid in its recognition and management.
  
  
  METHODS
  Subanalysis of a large case-control study from January 2000 to December 2004 in 17 hospitals in the Pediatric Emergency Care Applied Research Network was performed. Cases were children younger than 16 years with AARS after blunt trauma (n = 55); controls were (a) children with other cervical spine injuries (other CSI, n = 485) and (b) those with normal imaging of the cervical spine (non-CSI, n = 1060).
  
  
  RESULTS
  Children with AARS were younger (mean [SD] age, 7.7 [3.8] vs 10.7 [4.6]; Wilcoxon P < 0.01). Falls accounted for 36% of injuries; there were no diving mechanisms (vs other CSI, falls 19%, Fisher exact P < 0.01, and diving 7%, P = 0.04). Children with AARS sought medical care more than 24 hours after the injury event (21% vs 1% for non-CSI controls, P < 0.01). Clinical findings associated with AARS included neck pain (67%) and torticollis (57%) versus other CSI, pain (47%) and torticollis (5%, P < 0.01) for each, and versus non-CSI controls, pain (33%) and torticollis (6%, P < 0.01) for each. Management of AARS included no intervention (n = 6, 11%), soft or rigid collar only (n = 24, 44%), traction (n = 14, 25%), halo (n = 9, 16%), internal fixation (n = 2, 4%), and varied across institutions (P = 0.02).
  
  
  CONCLUSIONS
  Children with AARS often have a delayed presentation with neck pain and torticollis; falls are a common injury mechanism. Treatment varied across institutions. Further work is needed to identify optimal management.
authors.affiliation: From the *Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL; †Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine; ‡Central Data Management and Coordinating Center, University of Utah School of Medicine, Salt Lake City, UT; §Department of Pediatrics, Division of Emergency Medicine, and Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis Children's Hospital, St. Louis, MO; ∥Department of Pediatrics, Division of Emergency Medicine, Johns Hopkins School of Medicine, Johns Hopkins Children's Center, Baltimore, MD; and **Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Powell
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
authors.forename: Cody S
authors.initials: CS
authors.lastname: Olsen
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anders
authors.forename: Julie C
authors.initials: JC
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000293:injuries*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D019838:Neck Injuries / Q000175:diagnosis* / Q000628:therapy; D013124:Spinal Injuries / Q000175:diagnosis* / Q000628:therapy