Traumatic rotary posterior dislocation of the atlas on the axis without fracture. Report of a case and review of literature

BackgroundTraumatic rotary posterior dislocation of C1 on C2 without fracture (TRPDAAWF) is a very rare complication in severe accidents, and its pathophysiology is still under debate.Case DescriptionAlthough 6 similar cases have been reported previously, we report the lessons learned during handling of the patient. A young man who is a victim of severe car crash injury, with neglected displacement of the intact odontoid process to the front of the anterior arch of C1, is reported. Some problematic and life-threatening events in the management of the case are presented.ConclusionsWe report a new and rare case of TRPDAAWF. It is hypothesized that a similar situation could only be possible if rotary subluxation of C1 on C2 follows a severe hyperextension injury; otherwise, traumatic fracture of the odontoid process might have been inevitable.