Objectives. To analyse the causes of atlanto-axial rotatory fixation (
AARF) and discuss the diagnosis and treatment. Design. Retrospective c
ase studies. Setting. Medical University of Southern Africa - Ga-Ranku
wa referral hospital.Patients. A total of 10 patients admitted to and
treated in the Department of Orthopaedics, Ga-Rankuwa Hospital, betwee
n July 1989 and June 1993. Outcome measure. Dynamic computed tomograph
y (CT) scan. Results. Upper respiratory tract infection and trauma wer
e the commonest causes of AARF. There was a delay in diagnosis ranging
between 4 weeks and 2 years 6 months. Clinical and radiological reduc
tion was obtained by gradual skeletal traction in 6 patients. Two pati
ents had improvement of the torticollis but stilt had subluxation on t
he CT scan. In 1 patient no reduction was obtained on occipitocervical
fusion and transoral decompression was necessary. In 1 case the paren
ts refused any form of treatment. There was no recurrence in the 7 pat
ients followed up (minimum 6 months). Conclusion. This study shows tha
t AARF is often diagnosed late. The patients diagnosed early responded
well to skeletal fraction followed by external support. In patients d
iagnosed late the AARF could not be reduced completely and needed surg
ical fusion. If untreated, conditon can be complicated by tetraparesis
.