Case Report Case Report of a Traumatic Atlantoaxial Rotatory Subluxation with Bilateral Locked Cervical Facets: Management, Treatment, and Outcome Nael Hawi, 1 Dirk Alfke, 2 Emmanouil Liodakis, 1 Mohamed Omar, 1 Christian Krettek, 1 Christian Walter Müller, 1 and Rupert Meller 1 1 Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany 2 Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany Correspondence should be addressed to Emmanouil Liodakis; manoliodakis@yahoo.gr Received 17 December 2015; Revised 7 February 2016; Accepted 15 March 2016 Academic Editor: William B. Rodgers Copyright © 2016 Nael Hawi et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Te aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. Management consisted of analgesia, sedation, and application of a halo skull traction device. Afer removing halo skull traction, full reduction and recovery were achieved without instability. 1. Introduction Isolated traumatic atlantoaxial rotatory subluxation in adults represents a rare entity. Few cases about subluxation and dis- location have been described in the literature. We defne the term subluxation similar to the defnition used by Venkatesan et al. [1]: a partial and transient reducible displacement of the adjacent articular surfaces at this level. We present a rare case of traumatic atlantoaxial rotatory subluxation with frst presented clinical (video/photo) and radiological (computed tomography/magnetic resonance) imaging of examination, management, treatment, and out- come. 2. Case Report A ft 34-year-old woman presented afer an automobile accident: a head-on collision as driver at a speed of 43.5 mph (70 km/h). Tere was no loss of consciousness, nausea, or vertigo afer the accident. Te patient’s neck was stabilized at the accident site (routine procedure with a stif neck) and she was conveyed to the hospital. She had isolated pain in the cervical neck, with a combination of torticollis, a typical cock robin position of the head, and motion-related pain in the cer- vical neck with loss of range of motion to the lef side (Video 1 in Supplementary Material available online at http://dx.doi.org/10.1155/2016/7308653). She exhibited cervi- cooccipital tenderness. Tere was no neurological defcit. She had no previous history concerning cervical spine injuries. Afer conventional radiological imaging of the upper spine, computed tomography revealed atlantoaxial rotatory subluxation. Te facet of the atlas of one side was dislocated anteriorly over the facet of the axis, whereas the contralateral facet was dislocated/subluxated posteriorly over the facet of the axis. Te atlantodental interval was not apparently widened, and there were no associated fractures. Management consisted of analgesia (0.3 mg fentanyl), sedation (3 mg midazolam), and application of a halo skull traction device under fuoroscopy (10 lbs, 4.5 kg). Afer appli- cation of the halo skull traction device, computed tomog- raphy and magnetic resonance imaging were performed; they revealed full reduction of the subluxation without any ligamentous injuries (Figures 1–5). Afer 2 weeks, halo skull traction was removed, and pain-free and nearly free motion of the neck was observed (Video 1). Te patient’s neck was immobilized with a rigid collar for the next 6 weeks. Hindawi Publishing Corporation Case Reports in Orthopedics Volume 2016, Article ID 7308653, 4 pages http://dx.doi.org/10.1155/2016/7308653