Surgical Management of Adult Traumatic Atlantoaxial Rotatory Fixation with Hangman Fracture: Case Report and Literature Review

Document Type : CASE REPORT


1 Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran


Atlantoaxial rotatory fixation (AARF) is a rare type of adult cervical spine injury. The classic symptoms 
are painful torticollis and limited neck range of motion. To avoid catastrophic consequences, early 
diagnosis is necessary. The present study presents the successful treatment of a scarce case of adult 
AARF with a Hangman fracture and a comprehensive literature review. A 25 -year-old man presented to 
the trauma bay with left-sided torticollis after a motor vehicle accident. Cervical computed tomography 
scans revealed type I AARF. Torticollis resolved after cervical traction with partial reduction, and 
posterior C1-C2 fusion was performed as part of the therapy. Recognition of AARF after trauma requires 
a high index of suspicion, and early diagnosis is critical for the achievement of the best possible patient 
outcomes. Since the combination of a Hangman fracture and C1-C2 rotatory fixation is complex and 
unique, it must be tailored to the associated injuries.
 Level of evidence: IV


Main Subjects

Volume 11, Issue 4
April 2023
Pages 301-305
  • Receive Date: 11 November 2022
  • Revise Date: 04 December 2022
  • Accept Date: 07 December 2022
  • First Publish Date: 18 March 2023