Blackwood NJ Atlo-Occipital Dislocation: A Case of Fracture of the Atlas and Axis, and Forward Dislocation of the Occiput on the Spinal Column, Life being Maintained for Thirty-four Hours and Forty Minutes by Artificial Respiration, during which a Laminectomy was Performed upon the Third Cervical Vertebra. Ann Surg. 1908; 47:(5)654-8

Chattar-Cora D, Valenziano CP Atlanto-occipital dislocation: a report of three patients and a review. J Orthop Trauma. 2000; 14:(5)370-5

Ehlinger M, Charles YP, Adam P Survivor of a traumatic atlanto-occipital dislocation. Orthop Traumatol Surg Res. 2011; 97:(3)335-40

Gluncic V, Turner M, Kranzler L Timely recognition of traumatic atlanto-occipital dislocation in a child based on occipital condyle-C1 interval analysis: excellent neurological recovery. J Neurosurg Pediatr. 2010; 5:(5)465-9

Henry MB, Angelastro DB, Gillen JP Unrecognized traumatic atlanto-occipital dislocation. Am J Emerg Med. 1998; 16:(4)406-8

Hosalkar HS, Cain EL, Horn D Traumatic atlanto-occipital dislocation in children. J Bone Joint Surg Am. 2005; 87:(11)2480-8

Houle P, McDonnell DE, Vender J Traumatic atlanto-occipital dislocation in children. Pediatr Neurosurg. 2001; 34:(4)193-7

Labler L, Eid K, Platz A Atlanto-occipital dislocation: four case reports of survival in adults and review of the literature. Eur Spine J. 2004; 13:(2)172-80

McElwee K, Wargo CA Traumatic atlanto-occipital dislocation: a paediatric case report. J Trauma Nurs. 2006; 13:(4)186-9

Przybylski GJ, Clyde BL, Fitz CR Craniocervical junction subarachnoid hemorrhage associated with atlanto-occipital dislocation. Spine (Phila Pa 1976). 1996; 21:(15)1761-8

Atlanto-occipital dislocation in children: saving a life in the trauma field

01 September 2012
Volume 2 · Issue 3


Traumatic atlanto-occipital dislocation is (AOD) a serious injury of the cervical spine that occurs in children. It is more common than previously thought and is estimated to account for 6–8 % of all fatal traffic injuries. The cause is usually a high energy trauma, resulting in a disruption of the ligaments and membranes that give support to the craniocervical junction between the occiput and the proximal cervical vertebrae. These supporting structures are incompletely developed in children, thus predisposing the paediatric population to develop an atlanto-occipital dislocation under traumatic circumstances. Early recognition and improved pre-hospital care have increased the survival rate and yielded a better prognosis for these children. Therefore, every high energy trauma, for example a traffic accident, should raise suspicion of atlanto-occipital dislocation, especially if combined with a significant head injury. Furthermore, symptoms originating from brain stem and spinal cord injury may be another sign of a dislocation. Early recognition of a possible atlanto-occipital dislocation, stabilisation and management in the trauma field and rapid transportation to the hospital are measures that improve the survival rate and prognosis of these children.

Traumatic atlanto-occipital dislocation (AOD) is a rare but frequently fatal injury occurring at the craniocervical junction between the base of the skull (occiput) and the proximal cervical vertebrae (atlas) (C1) and axis (C2) (Figure 1). It is generally seen in young children and adolescents (Przybylsk et al, 1996; Hosalker et al, 2005; Garrett et al, 2010), however, this injury is not as uncommon as previously thought, as it accounts for approximately 6–8 % of all fatal traffic injuries occurring in children. Moreover, of those with a fatality that is directly related to the cervical spine injury, 20–30 % result from an AOD (Hosalkar et al, 2005; Garratt et al, 2010; Ehlinger et al, 2011).

Subscribe to get full access to International Paramedic Practice

Thank you for visiting International Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed