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[Atlanto-axial rotational subluxation in children: therapy in delayed diagnosis]
P Engelhardt1, D Fröhlich, F Magerl
1Klinik für Orthopädische Chirurgie Kantonsspital St. Gallen.
Insights
Rotatory subluxation can cause pediatric torticollis spontaneously or after minor events. Prompt diagnosis and a treatment regimen of mobilization, Halo fixation, and Minerva casting proved successful in three pediatric cases.
Area of Science:
- Pediatric Orthopedics
- Neurology
Background:
- Torticollis in children can arise from various causes including rotatory subluxation, often following minor trauma, upper respiratory infections, or oropharyngeal surgery.
- Spontaneous onset of torticollis due to rotatory subluxation also occurs, highlighting the need for broad diagnostic considerations.
Observation:
- This report details three pediatric cases of torticollis resulting from rotatory subluxation where diagnosis was delayed.
- Typical symptoms and differential diagnoses for pediatric torticollis are reviewed.
Findings:
- A treatment protocol involving mobilization under general anesthesia, temporary Halo fixation, and subsequent Minerva cast immobilization for 4-8 weeks was implemented.
- This therapeutic approach demonstrated success in resolving torticollis in all three presented cases.
Implications:
- The findings suggest that a structured treatment approach combining surgical intervention and casting is effective for pediatric rotatory subluxation-induced torticollis.
- Early and accurate diagnosis is crucial for optimal outcomes in children presenting with torticollis.
Abstract:
Children may develop a torticollis due to Rotatory Subluxation not only after minor trauma, infections of the upper respiratory tract, surgical procedures in the oropharynx but also spontaneously. Three cases with a delay in diagnosis are presented; the typical symptoms and other causes of torticollis are discussed. The suggested treatment is mobilisation under general anaesthesia, fixation with a Halo for a few days and consecutive immobilisation in a Minerva cast for 4-8 weeks. This regimen was successful in all three cases.