title: Atlanto-axial rotatory fixation.
abstract: OBJECTIVE
  To analyse the causes of atlanto-axial rotatory fixation (AARF) and discuss the diagnosis and treatment.
  
  
  METHODS
  Retrospective case studies.
  
  
  METHODS
  Medical University of Southern Africa-Ga-Rankuwa referral hospital.
  
  
  METHODS
  A total of 10 patients admitted to and treated in the Department of Orthopaedics, Ga-Rankuwa Hospital, between July 1989 and June 1993.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Spine Unit, Ga-Rankuwa Hospital.
authors.forename: M
authors.initials: M
authors.lastname: Lukhele
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013019:South Africa; D013123:Spinal Fusion; D013997:Time Factors; D014103:Torticollis / Q000175:diagnosis / Q000209:etiology; D014143:Traction