Treatments of atlanto-axial rotatory subluxation in children are generally conservative. Previous reports have proposed that surgical treatment be reserved for fixed rotatory subluxation of more than 3 months duration, irreducible deformity or cases of recurrence. Six skeletally immature patients with Fielding type III atlanto-axial rotatory subluxation were treated conservatively with or without subsequent atlanto-axial arthrodesis. The follow-up period for all the cases exceeded 18 months. Results and outcomes were analysed with an emphasis on the delay until diagnosis, causes of delays in diagnosis and factors influencing the necessity of surgical intervention. Neither mortality nor major morbidity was noted in any cases in this study. In our experience, type III fixed rotatory subluxation of 6 weeks duration will potentially recur. We recommend early surgery for type III fixed rotatory subluxation of more than than 3 months' duration, with atlanto-axial arthrodesis being a safe and effective procedure in children.
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