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Abstract
The patients were three girls between 6 and 10 years. One case occurred after general anaesthesia with intubation for arteriography, and two after trauma with fracture of the clavicle. In all three cases, there was rotation of at least 30 degrees between atlas and axis, but the anterior arch of the atlas remained in close contact with the odontoid, unlike true dislocation of the atlas. Pain was so intense in each case that exact manual examination, let alone mobilisation or manipulation without general anaesthesia, was out of the question. As the only alternative was surgical intervention, manipulation under general anaesthesia was carried out, following the x-ray findings.
In all three cases there was immediate improvement after manipulation. One patient was immediately free of symptoms, one was manipulated twice, and one required mobilisation after the first manipulation - this was well-tolerated. The effects are well-documented by conventional radiographs in two cases, and by CT in one case (treated by Dr Rosina in Poprad).