Management of Pediatric Atlantoaxial Rotatory Subluxation with a Simple Handmade Cervical Traction Device: Doing More with Less

Abstract

To introduce a novel traction device for management of pediatric atlanto-axial rotatory subluxation (AARS) in source limiting areas. Atlanto-axial (C1-C2) joint is accountable for up to two third of total axial craniocervical rotation. Its major role in pivotal rotation of cervical spine makes it more vulnerable to a certain type of injury known as AARS. Management of AARS is based on the Fielding classification which includes closed reduction and immobilization and cervical fusion in unstable cases. There are several cervical traction devices including the Gardner-Wells tongs and halter traction device. All the available devices require insertion of pins into the calvarial periosteum which is a painful, invasive and intolerable procedure especially for the pediatric patients. We designed a simple hand-made cervical traction device which is composed of 2 soft padded straps (40 × 4 cm) and 2 connecting strings which can be applied easily under the chin and occipital areas of the patients. We successfully treated a 9-year-old girl with AARS with the device. The advantage of the device is its available, inexpensive and non-invasive and the patient might tolerate it more easily compared to the previously designed instruments. This hand-made simple cervical traction device in source limiting centers and hospitals is a good example of doing more with less. It was effective and the tolerance of the patient was acceptable. Further studies with larger series are required for providing appropriate evidence.