Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2021; 9(6): 1461-1468
Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1461
Early reoccurrence of traumatic posterior atlantoaxial dislocation without fracture: A case report
Ying-Hua Sun, Li Wang, Jin-Ting Ren, Su-Xia Wang, Zhao-De Jiao, Jun Fang
Ying-Hua Sun, Li Wang, Jin-Ting Ren, Su-Xia Wang, Zhao-De Jiao, Jun Fang, Department of Orthopedics, Yidu Central Hospital, Weifang Medical University, Qingzhou 262500, Shandong Province, China
Author contributions: Sun YH and Wang L were major contributors to the writing of this manuscript; Sun YH, Wang L, Ren JT, and Fang J performed the diagnostic investigations and treatments; Wang SX and Jiao ZD collected the pertinent literature; All authors have read and approved the final version of the manuscript.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jun Fang, PhD, Chief Doctor, Dean, Professor, Surgeon, Department of Orthopedics, Yidu Central Hospital, Weifang Medical University, No. 4138 South Linglongshan Road, Qingzhou 262500, Shandong Province, China.
Received: October 31, 2020
Peer-review started: October 31, 2020
First decision: December 8, 2020
Revised: December 21, 2020
Accepted: December 30, 2020
Article in press: December 30, 2020
Published online: February 26, 2021

In general, atlantoaxial dislocation is rare due to the stability of the C1-C2 complex. Traumatic atlantoaxial dislocations are usually anterior and accompanied by odontoid fractures. Posterior atlantoaxial dislocations are rare, and complete posterior dislocation without associated fracture is even more rare. A case of early recurrence of posterior atlantoaxial dislocation without fracture being in therapy of first closed reduction and then open reduction has not been previously reported.


A 45-year-old female presented with traumatic posterior atlantoaxial dislocation (TPAD) of C1-C2 without associated fractures, and Frankel Grade B spinal cord function. She was successfully managed by immediate closed reduction under skull traction. Unexpectedly, 17 d later, re-dislocation was discovered. On day 28, closed reduction was performed as before but failed. Then, open reduction and posterior internal fixation with autologous iliac bone grafts was performed. By 6 mo after surgery, atlantoaxial joint fusion was achieved, and neurological function had recovered to Frankel Grade E. At 12 mo follow-up, she had lost only 15° of cervical rotation, and atlantoaxial complex instability in joint flexing and extending were no longer observed under fluoroscopy.


Early assessment of transverse ligament is critical for TPAD without fracture avoiding re-dislocation after closed reduction.

Keywords: Reoccurrence, Traumatic posterior atlantoaxial dislocation, Without fracture, Transverse ligament, Case report

Core Tip: Traumatic posterior atlantoaxial dislocations (TPADs) without fracture are rare. In this article, we present a 45-year-old female with early recurrence of TPAD of C1-C2 without associated fractures. The patient first underwent closed reduction and then open reduction, internal fixation, and interfacial fusion. Excellent results were achieved. In conclusion, early assessment of the condition of the transverse ligament is critical for the prevention and early discovery of the re-dislocation of TPADs.