While driving a van and wearing a seatbelt, a 19-year-old Caucasian woman, was involved in a head-on vehicle collision (speed about 40 km/hour), followed by a rear-end hit from another vehicle. When rescue services arrived at the scene, the patient was found sitting in her car with her head immobilized in a left rotation. She was transferred onto a spinal board. The application of a stiff neck collar was not possible as her head was fixed in the rotated position. After admittance to a regional hospital, the physician in charge tried to reposition her head but she reported painful paresthesia in the left arm. She was transferred to our spine and trauma center. Upon admittance, the woman complained about strong, immobilizing pain in the upper cervical spine with torticollis to the left side. A computed tomography (CT) scan revealed an atlantoaxial rotation of 46  to the left without any signs of osseous lesions (Figure 1). The neck was then reduced by cautious rotation under traction with the cervical spine in flexion thus avoiding harm by potential posttraumatic disc lesions. During this process, the patient was awake and did not report any new paresthetic sensations during the procedure. There were no clinical signs of neurological sequelae before or after reduction. However, a fluoroscopic control still showed signs of atlantoaxial pathology (Figure 2) and magnetic resonance imaging (MRI) of the cervical spine was done (Figure 3). It showed the integrity of the transverse and the alar ligaments and a traumatic discus protrusion on level C5/6 (Figure 4). After three days of immobilization and analgesic therapy, a CT (with maximum bilateral head rotation) showed no persisting atlantoaxial fixation (Figure 5). Subsequently, she was discharged three days after admittance and immobilized in a soft collar for six weeks. At a follow-up examination six weeks after the trauma, the pain and paresthesia in the left arm had receded completely and the patient had a full range of motion. A follow-up MRI of the cervical spine showed only slight persistent atlantoaxial rotational displacement of C1/2.