What question did this study set out to answer?

To evaluate the effectiveness of closed reduction for treating traumatic C1-C2 rotary subluxation in a child.

April 22, 2026BMJ Case Reports0 citations

Closed reduction in the emergency room following traumatic C1-C2 rotary subluxation: a paediatric perspective

DSDevika A. ShenoyDuke University RVRaelynn VigueDuke University IIIryna IvasykDuke University

Key Points

To evaluate the effectiveness of closed reduction for treating traumatic C1-C2 rotary subluxation in a child.
Presented a case of a child with AARS after a fall
Performed closed reduction under sedation in the emergency department
Followed up at two weeks for clinical and radiographic recovery
Successful closed reduction restored alignment of C1 on C2
Patient showed full recovery at the two-week follow-up
Non-operative management led to a return to normal function

Abstract

Atlantoaxial rotatory subluxation (AARS) represents a significant cause of acute torticollis in children involving rotational displacement of C1 on C2. Unlike common idiopathic torticollis, AARS represents a true subluxation that frequently necessitates reduction by an experienced provider to restore alignment. Here, we present the case of a child who developed AARS after falling out of bed. A CT scan confirmed acute C1–C2 rotatory subluxation. The patient was successfully treated with closed reduction under sedation in the emergency department by a paediatric spine surgeon, followed by immobilisation in a cervical collar. At the 2-week follow-up, she had achieved a full clinical and radiographic recovery with a return to normal function. This case underscores the necessity of maintaining a high index of suspicion for AARS in traumatic paediatric torticollis, highlights the role of advanced imaging in reaching a definitive diagnosis and confirms that non-operative management can lead to excellent outcomes.

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