title: Atlantoaxial rotatory fixation--a cause of torticollis.
abstract: BACKGROUND
  A rare, but important cause of torticollis in children is atlantoaxial rotatory fixation. If the patient remains undiagnosed for more than three months, surgery is generally the only therapeutic alternative. In this article we present our experiences of surgical treatment of late-diagnosed atlantoaxial rotatory fixation in children.
  
  
  METHODS
  This article is based on a review of the case notes of patients who underwent surgery for atlantoaxial rotatory fixation in the Department for Neurosurgery at Oslo University Hospital, Rikshospitalet, during the period 2004-10.
  
  
  RESULTS
  The material sample consists of six children aged from seven to 14 years. Five had suffered minor trauma to the upper neck region, while one had had an upper respiratory tract infection. The diagnosis was made 5-36 months after the onset of symptoms. In three of the patients, an attempt was made at closed reduction without success. A CT scan one year postoperatively showed a normal position of the atlantoaxial joint in two patients and partial reduction in three. In the sixth patient there was bone fusion at the time of the operation, and open reduction was unsuccessful. All six patients had reduced rotational movement of the neck at the one-year check-up.
  
  
  CONCLUSIONS
  All our patients were diagnosed more than five months after the onset of symptoms. Full or partial reduction was achieved in five of the six.
authors: Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Norway. jarle.sundseth@rikshospitalet.no
authors: Jarle
authors: J
authors: Sundseth
authors: Jon
authors: J
authors: Berg-Johnsen
authors: Sigrun
authors: S
authors: Skaar-Holme
authors: Mark
authors: M
authors: Züchner
authors: Frode
authors: F
authors: Kolstad
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D001368:Axis, Cervical Vertebra / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D001863:Bone Screws; D001864:Bone Wires; D001270:Cervical Atlas / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D002648:Child; D057210:Delayed Diagnosis; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome