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BMJ Case Rep. 2014 May 15;2014. pii: bcr2013202990. doi: 10.1136/bcr-2013-202990.

Atlantoaxial rotatory subluxation as a cause of torticollis in a 5-year-old girl.

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Department of Trauma and Orthopaedics, Sunderland Royal Hospital, Sunderland, UK.


Many patients present to the emergency department complaining of a sore or stiff neck and lateral flexion of the neck with contralateral rotation. Under the pressure of the breaching time and busy shifts some of the patients are discharged to the care of their general practitioners without adequate investigations. While most of the cases are due to benign causes, torticollis can be due to many congenital and acquired pathologies, some of which may need further investigation and urgent management. Atlantoaxial subluxation (AAS), tumours of the base of the skull and infections are among these causes. Delayed diagnosis may lead to worsening neurology and complicate the management. We report a case of a 5-year-old girl who presented to our fracture clinic with a fractured clavicle and torticollis; her subsequent investigations confirmed the diagnosis of AAS. Our patient responded to non-operative treatment and improved with no neurological complications.

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