Clavicle fracture associated with atlantoaxial rotatory displacement, type II in an 8-year-old girl

Abstract

Rationale:Fracture of the clavicle is a very common injury in children. However, association between clavicle fracture and atlantoaxial rotatory displacement is rarely observed.Patient concerns:We present a case of an 8-year-old girl, who suffered a right clavicle fracture as a result of a sledge accident. Six weeks after figure of 8 casting for a right clavicle fracture, an 8-year-old girl was brought to the Pediatric Orthopedic Department due to torticollis.Diagnoses:Standard X-ray examination revealed nonunion of the clavicle without any clinical symptoms. Computed tomography (CT) examination was performed and subluxation of cervical vertebrae 1/cervical vertebrae 2 was detected.Interventions:The use of Glisson's traction followed by a soft cervical collar resulted in the resolution of all the symptoms. Control CT and magnetic resonance imaging confirmed reduction.Outcomes:The patient fully recovered and currently is fully active. The neurological status of the child before and after procedure remained normal.Lessons:Clavicle fracture rarely may be associated with atlantoaxial rotatory displacement. Therefore, careful examination including rotation of the neck is necessary to confirm that associations. Moreover, three-dimensional CT scan enables proper spine examination and provides correct diagnosis. As shown in available literature and as well in presented case report, none operative treatment is usually effective.

Atlantoaxial Rotatory Subluxation in a 10-Year-Old Boy

“…1 Following a minor trauma, the development of cervical instability is more likely in children because of increased ligamentous laxity related to estrogen function. 2 Infectious and some inflammatory processes are also considered as underlying, precipitating causes. 3 There are several ways in which a subluxation can present, including anteroposterior, rotatory, vertical, and lateral subluxations.…”