European Orthopaedics and Traumatology

, Volume 5, Issue 4, pp 371–374 | Cite as

Delayed diagnosis of atlanto-axial rotatory subluxation with subsequent occipito-atlantal rotatory subluxation

  • Anil Singh DhadwalEmail author
  • Andrew Clarke
  • Abhinav Singh
  • Dan Chan
  • Mike Hutton
Case Report


Acquired torticollis in the paediatric population has a variety of aetiologies, yet often causes the same anatomical derangement of the atlanto-axial joint. Delayed diagnosis can lead to the occipito-atlantal joint trying to accommodate the torticollis, leading to instability of this joint. We report the case of a boy referred to our Regional Paediatric Spine service.

Case report

A fit and well 13-year-old male developed a right-sided torticollis 6 months prior to referral to the Peninsula Spine Unit. Both the patient and his family could not remember any predisposing events such as traumatic injury nor recent upper respiratory tract infection.

The patient had been reviewed by his local paediatric service, and a magnetic resonance scan had been performed on both brain and cervical spine. This was reported as normal. Four months later, he was assessed in the paediatric orthopaedic service at the same institution. His case was then discussed with our unit and a computerised...


Cervical Spine Computerise Tomogram Polyaxial Screw Rotatory Subluxation Halo Traction 
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Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© EFORT 2014

Authors and Affiliations

  • Anil Singh Dhadwal
    • 1
    Email author
  • Andrew Clarke
    • 1
  • Abhinav Singh
    • 2
  • Dan Chan
    • 1
  • Mike Hutton
    • 1
  1. 1.Peninsula Spine Unit, Princess Elizabeth Orthopaedic CentreRoyal Devon and Exeter HospitalExeterUK
  2. 2.The Peninsula College of Medicine and DentistryUniversity of Exeter and University of PlymouthPlymouthUK

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