Midshaft clavicle fractures associated with atlantoaxial rotatory displacement: a report of two cases.

Abstract

Two cases of clavicle fractures associated with atlantoaxial rotatory displacement as well as 11 additional cases from the literature are presented. Most cases occur in girls 6 to 10 years old. The head is most often laterally bent toward and rotated away from the fractured clavicle. There is often a delay in making the diagnosis, which is best demonstrated by dynamic CT. Treatment of the clavicle fracture is straightforward, but failure to recognize and treat the C1-2 rotatory displacement promptly can lead to fixed C1-2 deformity. Displacement recognized within the first 3 weeks of injury can be successfully treated nonoperatively. A delay of 6 weeks or greater in the diagnosis leads to fixed deformity at C1-2 that can be addressed with a limited cervical fusion.