A diagnose not to miss: Rotatory Atlantoaxial subluxation in emergency service

Amaç: Bu çalışmanın amacı, acil servislerde özellikle pediyatrik popülasyonda kolaylıkla yanlış tanı alabilecek atlantoaksiyel subluksasyonlara dikkat çekmektir. Acil servislerde erken tanı konulduğunda; kolaylıkla düzeltilebilir ve konservatif tedavi ihtimali daha yüksektir. Yöntem: Acil servisimize 1 Temmuz 2013-1 Eylül 2014 arasında başvuran; 5 ve 13 yaşları arasında atlantoaksiyel rotatuvar subluksasyonlu (AARS) 7 hasta retrospektif olarak incelendi. Bulgular: Tüm hastalar yatak istirahati, kas gevşetici ve sert boyunluk ile konservatif olarak tedavi edildi. Hiçbirinde cerrahi ihtiyacı olmadı. Sonuç: Atlaktoaksiyel rotatuvar subluksasyon (AARS) pediyatrik hastalarda görülen başlıca servikal omurga anomali tiplerinden biridir ve sıklıkla yanlış tanı konulan nadir bir durumdur; bu nedenle özellikle acil servislerde yanlış yönetilebilmektedir. Tanı için yüksek oranda şüphe duymak gerekmektedir. Pekçok pediyatrik servikal omurga yaralanması eksternal immobilizasyon ile tedavi edilebilir ve AARS hemen daima redükte edilebilirdir. Pediyatrik popülasyon ligamentöz laksite nedeni ile üst omurga yaralanmalarına meyillidir ve AARS özellikle acil servislerde her zaman akılda tutulmalıdır.

Kaçırılmaması gereken bir tanı: Acil serviste Rotatuvar Atlantoaksiyel subluksasyon

Objective: The objective of this study is to take attention to atlantoaxial subluxations especially in pediatric population that may be misdiagnosed in the emergency services easily. When diagnosed early in the emergency services, it may be corrected with ease and the treatment is more likely to be conservative. Method: Seven patients with atlantoaxial rotatory subluxation (AARS), between ages of 5 and 13, who admitted to our emergency service between 1 July 2013 - 1 September 2014 were examined retrospectively. Results: All patients were treated conservatively with bed rest, muscle relaxants and rigid cervical collar. None of them needed surgery. Conclusions: Atlantoaxial rotatory subluxation (AARS) is one of the main types of cervical spine anomalies seen in pediatric patients and is a rare condition that is often misdiagnosed and therefore incorrectly managed especially in emergency services. The diagnosis requires a high index of suspicion. Many pediatric cervical spine injuries can be treated with external immobilization and AARS is almost always reducible. Pediatric population is prone to upper spine injuries due t o ligamentous laxity and AARS should always be kept in mind especially in emergency services.

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