Fracture of the clavicle associated with a rotatory atlantoaxial subluxation

Abstract

A 6-year-old girl tripped over a football and landed on her right shoulder. Clinical examination revealed a fracture of the right clavicle with torticollis. An X-ray of the right shoulder confirmed the angulated midshaft fracture of the clavicle. The patient was discharged with analgesics and a broad arm sling. She returned to the casualty department the next day with headache and vomiting. She was sent home on analgesics. Following a further re-attendance the next day she was noted to have a ‘Cock–Robin position’. Although the motion of the cervical spine was severely restricted in all directions with marked nuchal muscle spasm, the results of the neurological examination were normal. X-rays of the cervical spine then showed AARS (Fig. 1), which was confirmed, on computed tomography (CT) scan (Figs. 2 and 3). She was treated conservatively with continuous halter traction using 4-lb weight. The neck pain and torticollis resolved within 4 days. She was discharged home with a Philadelphia collar for 6 weeks. On follow-up 3 months later the patient was free from pain and torticollis and had resumed normal activity. 1.2. Case 2