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The Journal of Bone and Joint Surgery 78:431-6 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Open Reduction of Traumatic Atlanto-Axial Rotatory Dislocation with Use of the Extreme Lateral Approach. A Report of Two Cases*

H. ALAN CROCKARD, F.R.C.S.{dagger} and MYRON A. ROGERS, F.R.A.C.S.{dagger}, LONDON, UNITED KINGDOM

Investigation performed at the Department of Surgical Neurology, The National Hospital for Neurology and Neurosurgery, London


   Introduction
 
Irreducible rotatory injuries at the atlanto-axial level in children may result in torticollis and facial asymmetry4,10,22,25,35. The terminology associated with traumatic rotatory injuries at this level is somewhat confusing, and a clear distinction should be made between rotatory subluxation and rotatory dislocation, as the mechanisms of injury and the optimum management may differ. In this report, we use the term atlanto-axial rotatory dislocation to define a complete and persistent displacement of the adjacent articular surfaces at this level. Ideally, early closed manipulative reduction with use of distraction and derotation with spinal cord monitoring, followed by external bracing, restores both normal anatomical relationships and mobility in many patients. In some patients, however, the maneuver fails, and often the joint fuses spontaneously in malalignment. The exact cause of failure to achieve reduction is unclear.

The purpose of this report is to describe our operative approach and findings in two patients who . . . [Full Text of this Article]


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