{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:53:13Z","timestamp":1790315593769,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Atlantoaxial rotatory fixation (AARF) comprises a spectrum of abnormal rotational relationships between C1 (atlas) and C2 (axis). We aimed to evaluate the efficacy and long-term clinical outcomes of halter traction in treating patients diagnosed with primary AARF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included patients &lt;18 years of age who presented with new-onset painful torticollis, neck pain, and sternocleidomastoid muscle spasm, had an AARF diagnosis confirmed by use of 3-dimensional dynamic computed tomography, received in-hospital cervical halter traction under our treatment protocol, and were followed for \u226512 months. Radiographic and long-term clinical outcomes were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 43 patients (31 male and 12 female; average age of 7.9 years) satisfied the inclusion criteria. There were 5 acute, 6 subacute, and 32 chronic cases. The mean duration of initial symptoms prior to treatment was 12.1 weeks. Thirty-seven (86.0%) of the patients experienced previous minor trauma, and 6 (14.0%) had a recent history of upper-respiratory infection (Grisel syndrome). The mean duration of in-hospital traction was 17.6 days. The mean follow-up period was 8.5 years. Forty-two (97.7%) of the patients achieved normal cervical alignment after treatment. One patient (2.3%) had recurrence and received a second course of halter traction, with cervical alignment restored without any surgical intervention. No neurological deficits were noted during or after the treatment. No major complications were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Normal anatomy and restoration of cervical alignment can be achieved by cervical halter traction in most cases of AARF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.21.00831","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T14:06:16Z","timestamp":1640095576000},"page":"229-238","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Halter Traction for the Treatment of Atlantoaxial Rotatory Fixation"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2500-1635","authenticated-orcid":false,"given":"Chi-Yung","family":"Yeung","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"School of Medicine, National Defense Medical Center, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6328-4950","authenticated-orcid":false,"given":"Chi-Kuang","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"School of Medicine, National Defense Medical Center, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"issue":"3","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1227\/01.NEU.0000134386.31806.A6","article-title":"Atlantoaxial rotatory fixation: Part 1\u2014Biomechanics of normal rotation at the atlantoaxial joint in 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