Atlanto-axial rotatory fixation

Objectives. To analyse the causes of atlanto-axial rotatory fixation (AARF) and discuss the diagnosis and treatment. Design. Retrospective case studies. Setting. Medical University of Southern Africa - Ga-Rankuwa referral hospital. Patients. A total of 10 patients admitted to and treated in the Department of Orthopaedics, Ga-Rankuwa Hospital, between July 1989 and June 1993. Outcome measure. Dynamic computed tomography (CT) scan. Results. Upper respiratory tract infection and trauma were the commonest causes of AARF. There was a delay in diagnosis ranging between 4 weeks and 2 years 6 months. Clinical and radiological reduction was obtained by gradual skeletal traction in 6 patients. Two patients had improvement of the torticollis but stilt had subluxation on the CT scan. In 1 patient no reduction was obtained on occipitocervical fusion and transoral decompression was necessary. In 1 case the parents refused any form of treatment. There was no recurrence in the 7 patients followed up (minimum 6 months). Conclusion. This study shows that AARF is often diagnosed late. The patients diagnosed early responded well to skeletal fraction followed by external support. In patients diagnosed late the AARF could not be reduced completely and needed surgical fusion. If untreated, conditon can be complicated by tetraparesis.