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 still 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 traction followed by external support. In patients diagnosed late the AARF could not be reduced completely and needed surgical fusion. If untreated, condition can be complicated by tetraparesis.