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Case Reports in Orthopedics
Volume 2017, Article ID 1017307, 5 pages
Case Report

Fusion Surgery Required for Recurrent Pediatric Atlantoaxial Rotatory Fixation after Failure of Temporary Fixation with Instrumentation

1Orthopaedic Surgery, Sanmu Medical Center, 167 Naruto, Sanmu, Chiba 289-1326, Japan
2Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan

Correspondence should be addressed to Yoshiyuki Matsuyama; moc.liamg@fkjnuttam and Tetsuhiro Ishikawa; moc.liamtoh@utetetetetet

Received 15 August 2017; Accepted 21 November 2017; Published 26 December 2017

Academic Editor: Jae Taek Hong

Copyright © 2017 Yoshiyuki Matsuyama et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In cases of chronic irreducible and recurrent unstable atlantoaxial rotatory fixation (AARF), closed reduction and its maintenance are often unsuccessful, requiring surgical treatment. The purpose of the present report is to describe a rare case of pediatric AARF that required multiple treatments. A 6-year-old boy was diagnosed as having type 2 AARF. After conservative treatment, the patient was treated with temporary fixation surgery (C1-C2 Magerl) without a bone graft in consideration of motion preservation after screw removal. AARF recurred after the screw removal and required fusion surgery (Magerl–Brooks) with an iliac bone graft. Ultimately, bone union was achieved and the screws were removed 11 months after the surgery. We recommend surgeons be cautious when choosing temporary fixation surgery for AARF in small children. Further investigation is needed to determine the optimal time before screw removal.