Ronald Lehman, Daniel Riew, Klaus Schnake
Acute C1-C2 rotatory subluxation in children may be reduced by gentle traction using a head halter. When reduced it can be maintained in a collar.
Depending on the severity of the displacement or time of presentation halo traction may be necessary.
The head halter is installed with the patient in supine position. Traction is started with 4kg. Control X-rays are used to verify reduction.
In acute cases, reduction will be achieved within 24h. If not, halo traction may be necessary, because the child will not support more than 4kg of traction over the chin and the skin may be damaged.
Once reduced, traction is continued for 24hours before a hard collar is applied.
The Philadelphia collar is used for the initial conservative treatment. It provides more stability than the hard collar.
If follow up X-ray show no displacement after 2 weeks, one can change to the hard collar for patient comfort.