Aims Although atlantoaxial rotatory fixation (AARF) is a common cause of torticollis in children, the diagnosis may be delayed. The condition is characterised by a lack of rotation at the atlantoaxial joint which becomes fixed in a rotated and subluxed position. The management of children with a delayed presentation of this condition is controversial. This is a retrospective study of a group of such children.
Patients and Methods Children who were admitted to two institutions between 1988 and 2014 with a diagnosis of AARF were included. We identified 12 children (four boys, eight girls), with a mean age of 7.3 years (1.5 to 13.4), in whom the duration of symptoms on presentation was at least four weeks (four to 39). All were treated with halo traction followed by a period of cervical immobilisation in a halo vest or a Minerva jacket. We describe a simple modification to the halo traction that allows the child to move their head whilst maintaining traction. The mean follow-up was 59.6 weeks (24 to 156).
Results Despite the delay in referral, the subluxation was successfully reduced in all children. Only two children required atlantoaxial fusion.
Conclusion The results of our study suggest that normal anatomy with restoration of movement may be achieved even in cases of AARF presenting late, obviating the need for fusion. We also show a simple modification to the halo traction that allows the child to move their head about while still maintaining traction.
Take home message: Prompt diagnosis and management with halo traction (with a simple modification as described) is associated with good results in patients with AARF who present late.
Cite this article: Bone Joint J 2016;98-B:715–20.
M. Mifsud: Data collection, Writing and correction of paper.
M. Abela: Study design, Data collection, Writing of paper.
N. I. L. Wilson: Study design, Review of paper.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by R. Jeffery and first proof edited by J. Scott.
- Received April 21, 2015.
- Accepted November 13, 2015.
- ©2016 The British Editorial Society of Bone & Joint Surgery