ATLANTOAXIAL ROTATORY FIXATION

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 .