The Atlanto-Axial Rotatory Fixation in Adult Treated by Non-Surgical Approach

Abstract

The atlanto-axial rotatory fixation (AARF) is a rare clinical condition that occurs more commonly in children than in adults. It is easy to misdiagnosis AARF because of peculiar feature of atlanto-axial articulation. The authors reported a case of AARF in an adult who was treated by im-mobilization without surgery. Due to a traffic accident, the patient’s head was forcefully rotated to the right side and flexed to the left side. The patient had no neurological deficit, but the patient’s head was fixed in a position rotated to the right and tilted to the left. In open mouth view and three dimensional CT reconstruction images the atlas was rotated to the right side and the anterior lip of left superior facet and left transverse process of axis were fractured. The patient underwent intermittent Halter-traction for seven days. After the Halter-traction, we gained successful reduction and posterior neck pain was subsided. After the reduction, Halo-vest was applied for three months and the patient recovered well without any neurological deficits. In some case of adult traumatic AARF patient, closed reduction and Halo-vast external fixation may be successful instead of open reduction and fixation. And if it is successful, we can avoid operative procedure. (J Kor Neurotraumatol Soc 2010;6:70-73)