High cervical tuberculosis is a rare condition, occurring in 0.3% to 1% of patients with tuberculous spondylitis. Until a more obvious and potentially dangerous complication develops, it is often overlooked or misdiagnosed. We review the presentation, management and outcome of patients with atlanto-axial tuberculosis.

The case notes and radiographs of five patients with atlanto-axial tuberculosis were reviewed and they were recalled for clinical assessment. The mean age of patients was 30 years (16 to 54). The mean time from presentation to diagnosis was 5.6 months (3 to 12). All patients presented with neck pain and stiffness, which three ascribed to previous trauma. Two patients had neurological deficit. Three had tuberculosis at other sites. All patients had prevertebral swelling on plain lateral cervical spine radiographs and a collection anterior to C1/2 on CT scan or MRI. Three of these patients underwent surgery, one for anterior abscess drainage and diagnosis, one for stabilisation and one for non-contigious spinal involvement. All received four-drug antituberculous medication for at least 6 months. A single patient was HIV positive. All patients did well, with complete resolution of neurological symptoms and instability and good recovery of range of motion.

Atlanto-axial tuberculosis is rare but carries the risk of instability and neurological compromise. Particularly in endemic areas, a high index of suspicion is necessary when patients present with neck pain. Non-operative management, with bracing and antituberculous agents, is adequate, with surgery indicated for instability.

The purpose of the study was to assess the accuracy of prereduction and postreduction obturator oblique radiographic views in the diagnosis of simple posterior hip dislocation, and to ascertain whether, in differentiating simple posterior hip dislocations from fracture dislocation, obturator oblique views are a safe diagnostic tool in the hands of junior registrars, trauma officers and community service doctors.

A sample group of prereduction and postreduction radiographs of patients who had sustained posterior hip dislocations (Thompson and Epstein type I to III) was collected. All patients then had CT scans of the hip to confirm the plain radiographic findings.

Shown only the radiographs, all junior doctors involved in the study correctly differentiated between simple posterior hip dislocations and fracture dislocations.

This has implications for savings in both time and money. If CT scans are unnecessary in simple posterior hip dislocation, the need for transfer and tertiary level hospitalisation is obviated.