title: Closed manual reduction maneuver of atlantoaxial rotatory dislocation in pediatric age.
abstract: OBJECTIVE
  The purposes of this study were to characterize the clinical and radiological features of type 1 and type 2 atlantoaxial rotatory dislocations (AARD) and to evaluate the outcome of the manual reduction maneuver for these types of dislocations in pediatric patients.
  
  
  METHODS
  This study considered 12 pediatric patients with AARD who were treated between January 2003 and March 2013. The diagnosis was established by clinical findings and 3D-CT. All of the patients were treated by closed manual reduction and then a cervical orthosis was performed. All of the patients were followed up at regular intervals.
  
  
  RESULTS
  The causes of the AARD were trauma (91.67 %) and infection (8.33 %). The time between onset of symptoms and admission to the hospital ranged from 16 days to 6 months. In radiological evaluation, the mean rotational angulation of the patients was 30.58°. The 3D-CT examination showed that six patients (50 %) had type 1 dislocation and six patients (50 %) had type 2 dislocation. All of the patients were treated by closed manual reduction and then a cervical orthosis was performed. For 11 patients (91.67 %), dislocation was successfully reducted and maintained. One patient (8.33 %) underwent surgery, following recurrence of the second closed reduction maneuver.
  
  
  CONCLUSIONS
  This preceding treatment method has successfully produced a fast and recurrence-free alignment on all except one of our patients. This technique can be a useful treatment alternative in carefully selected AARD cases. Future research is encouraged to improve decision making in the application of this treatment method and provide additional validation of the current findings.
authors.affiliation: Department of Neurosurgery, School of Medicine, University of Hacettepe, 06100, Sıhhiye, Ankara, Turkey, atik@hacettepe.edu.tr.
authors.forename: Atilla
authors.initials: A
authors.lastname: Akbay
authors.forename: Burçak
authors.initials: B
authors.lastname: Bilginer
authors.forename: Nejat
authors.initials: N
authors.lastname: Akalan
mesh_terms: D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery*; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods*; D009989:Orthotic Devices; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed