title: Successful reduction for a pediatric chronic atlantoaxial rotatory fixation (Grisel syndrome) with long-term halter traction: case report.
abstract: METHODS
  Clinical case report of atlantoaxial rotatory fixation (AARF) in a girl presenting with torticollis and neck pain.
  
  
  OBJECTIVE
  To report this rare case that was successfully treated with long-term traction and a brace.
  
  
  BACKGROUND
  AARF is a rare kind of subluxation that is a pathologic fixation of the atlas on the axis. It is most common in pediatric patients and is usually reduced easily with conservative treatments only in the acute stage. However, previously reported chronic AARFs have usually been treated with operative reductions. Although high success rates have been achieved with operative reduction in chronic cases of AARF, even successful operative reduction may result in significant neck motion limitation.
  
  
  METHODS
  A 9-year-old girl had torticollis of more than 3 months duration develop as a result of an upper respiratory infection. Dynamic computerized tomography showed consistent fixation of the atlantoaxial joint consistent with type 1 AARF according to the classification of Li and Pang. The patient was treated with halter traction of 5-lb weight for 6 weeks, and with a brace for 4 months and collar for 2 months.
  
  
  RESULTS
  We successfully treated this patient with chronic AARF only with cervical traction. She had full recovery of neck motion and normal atlantoaxial angle on follow-up computerized tomography after 6 months.
  
  
  CONCLUSIONS
  From this case, we suggest that long-term traction could be another treatment method for chronic AARF, especially in children.
authors.affiliation: Department of Neurosurgery, Kangwon National University College of Medicine, Chunchon, Korea.
authors.forename: Seoung Woo
authors.initials: SW
authors.lastname: Park
authors.forename: Ki Hong
authors.initials: KH
authors.lastname: Cho
authors.forename: Yong Sam
authors.initials: YS
authors.lastname: Shin
authors.forename: Se Hyuk
authors.initials: SH
authors.lastname: Kim
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Ahn
authors.forename: Kyung Gi
authors.initials: KG
authors.lastname: Cho
authors.forename: Ji Soon
authors.initials: JS
authors.lastname: Huh
authors.forename: Soo Han
authors.initials: SH
authors.lastname: Yoon
mesh_terms: D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D011859:Radiography; D013577:Syndrome; D013995:Time; D014103:Torticollis / Q000000981:diagnostic imaging* / Q000628:therapy; D014143:Traction / Q000379:methods*