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Successful Closed Reduction of Atlantoaxial Rotatory Fixation in Children-A Retrospective Study of 30 Patients
Ping Xu1, Zhiqiang Zhang1, Yiming Zheng1
1Department of Orthopedics, 145601National Children's Medical Center & Children's Hospital of Fudan University, Shanghai, China.
Insights
Pediatric patients with acute atlantoaxial rotatory fixation (AARF) treated with closed reduction showed successful outcomes, especially when intervention occurred within three months. Longer delays correlated with extended recovery times, highlighting the importance of timely treatment for better results.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Radiology
Background:
- Acute atlantoaxial rotatory fixation (AARF) is a rare condition in children.
- Delayed treatment can impact recovery outcomes.
- Understanding the relationship between treatment delay and recovery is crucial for effective management.
Purpose of the Study:
- To review treatment experience and investigate the disease progression of pediatric AARF patients.
- To evaluate the correlation between delayed treatment and clinical and radiological recovery.
- To assess the efficacy of closed reduction in managing AARF.
Main Methods:
- Retrospective cohort study of pediatric AARF patients treated with closed reduction.
- Patients divided into two groups based on delay time: Group I (1 month ≤ delay < 3 months) and Group II (delay < 1 month).
- Comparison of atlantodental interval (ADI), lateral mass-dens interval (LDI), and lateral joint space (LJS) at admission and follow-up; correlation analysis between delay time and recovery metrics.
Main Results:
- Significant reduction in LDI and LJS was observed between admission and final follow-up.
- A positive correlation was found between delayed treatment time and clinical recovery time (r = 0.63, p = 0.00).
- Delayed treatment also correlated positively with total recovery time (r = 0.47, p = 0.01).
Conclusions:
- Closed reduction is a successful treatment for pediatric AARF with delays less than three months.
- Longer delays necessitate longer traction periods, though cervical collar duration remains consistent.
- LDI and LJS measurements on anteroposterior X-rays are valuable for monitoring treatment progress.
Study Design:
Retrospective cohort study.
Objectives:
To review our treatment experience and to investigate the process of this disease.
Methods:
Clinical data of AARF patients, who received closed reduction, was retrospectively reviewed. Patients were divided into 2 groups according to the length of delay (Group I: 1 month ≤ delayed time < 3 months), Group II (delayed time < 1 months). The correlation between the length of delayed time and clinical recovery (CR), radiological recovery (RR), and total recovery time were measured. The atlantodental interval (ADI), lateral mass-dens interval (LDI) and lateral joint space (LJS) were compared at admission and final follow-up.
Results:
30 children (12 girls and 18 boys) with AARF had received conservative treatment. The mean age at initial treatment was 8.13-year-old, ranging from 5 to 14. The mean follow-up time was 26.93 months (range, 6-87 months). The average length of delayed time was 28.53 days (range, 2-80 days). When the LDI, LJS, and ADI differences are compared at admission and the final visit, the differences are reduced significantly on LDI and LJS. A positive correlation is observed between the length of the delay and CR time and total recovery time (r = 0.63, p = 0.00 and r = 0.47, p = 0.01) respectively.
Conclusions:
Pediatric AARF patients who have a delay time < 3 months can be treated with closed reduction successfully. The longer the delayed time, the longer the traction time, but the cervical collar time is almost the same. The LDI and LJS on the anteroposterior of X-rays are convenient to estimate the progress of this condition during the treatment.
