Atlantoaxial rotary subluxation in children

Traumatic torticollis is an uncommon complaint in the emergency department (ED), One important cause in children is atlantoaxial rotary subluxation, M ost children present with pain, torticollis ("cock-robin" position), and di minished range of motion. The onset is spontaneous and usually occurs follo wing minor trauma, A thorough history and physical ex-amination will elimin ate the various causes of torticollis. Radiographic evaluation will demonst rate persistent asymmetry of the odontoid in its relationship to the atlas. Computed tomography, especially a dynamic study, may be needed to verify t he subluxation, Treatment varies with severity and duration of the abnormal ity. For minor and acute cases, a soft cervical collar, rest, and analgesic s may be sufficient. For more severe cases, the child may be placed on head halter traction, and for long-standing cases, halo traction or even surgic al interventions may be indicated. We describe two patients with atlantoaxi al rotary subluxation, who presented with torticollis, to illustrate recogn ition and management in the ED.