Atlantoaxial rotary subluxation in children after trampoline injury: A critical but overlooked diagnosis

Atlanto-axial rotary subluxation (AARS) is rare but recognized as a significant cervical spine injury following a fall or physical impact on the head or neck in children aged 5-15 years. Trampoline use has been increasing among children, as have the trampoline-related injuries (TRI). We present a case series of AARS following trampoline injuries, highlighting clinical presentation, diagnosis, and management, especially in an emergency setting. We report four children with an average age of 8.5 years (range 6-12 years) presented to our hospital emergency service with neck pain and torticollis following a TRI. The diagnosis was confirmed through X-ray and computed tomography imaging, revealing Fielding and Hawkins type 1 AARS. Conservative treatment with analgesics, muscle relaxants, and a cervical collar led to recovery in three cases, while one required halter cervical traction for persistent deformity. All patients recovered completely, with no long-term complications. AARS in children is largely a type 1 injury with a favorable prognosis. Early recognition and management are crucial in preventing complications. The increasing incidence of neck injuries caused by trampoline use in children necessitates strict safety regulations regarding its use.