Fielding and Hawkins classification of atlantoaxial rotatory subluxation

Case contributed by Dr Behrang Amini

Fielding and Hawkins classified atlantoaxial rotatory subluxation into 4 types:

  • Type I: Simple rotatory displacement without anterior shift. The transverse ligament is intact and the dens acts as a pivot point.
  • Type II: Rotatory and anterior displacement between 3-5 mm. The transverse ligament is injured and the opposite facet acts as the pivot point.
  • Type III: Rotatory and anterior displacement greater than 5 mm with both lateral atlantoaxial joints anteriorly subluxed. The transverse ligament and facet capsules are injured.
  • Type IV: Posterior subluxation of both lateral atlantoaxial joints. Rare and described in adult patients with rheumatoid arthritis and destruction of the dens.
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Case information

rID: 42320
Published: 15th Jan 2016
Last edited: 14th Aug 2019
System: Spine
Inclusion in quiz mode: Excluded

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