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Traumatic Atlanto-Occipital Dissociation and Atlantoaxial Instability: Concomitant Ligamentous Injuries without Neurologic Deficit

A Case Report

Tobert, Daniel G., MD1,a; Ferrone, Marco L., MD2; Czuczman, Gregory J., MD3

doi: 10.2106/JBJS.CC.18.00021
Case Reports

Case: A 35-year-old man was involved in a motor-vehicle collision and sustained multiple thoracoabdominal and extremity injuries. A high injury burden and a normal neurologic examination contributed to a delay in diagnosing a ligamentous, combined atlanto-occipital dissociation (AOD) and vertical atlantoaxial injury (AAI). Additional imaging revealed the combined injury, and the patient underwent an occipitocervical fusion.

Conclusion: To our knowledge, this is the first case of a simultaneous traumatic AOD and AAI without fracture in a neurologically intact patient. Knowledge of reliable and easily applied radiographic relationships is important to expeditiously diagnose potentially lethal yet easily overlooked occipitocervical injuries.

1Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts

2Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

3Radiology Imaging Associates, Englewood, Colorado

aE-mail address for D.G. Tobert:

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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