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🏥 Gotokuji Orthopedic Clinic / Patient Guide

Atlantoaxial Rotatory Fixation

AARF
What to do when your child's neck is tilted and won't go back

The joint between the first cervical vertebra (atlas) and the second cervical vertebra (axis) at the very top of the neck becomes stuck in a twisted position and cannot return to normal.
It happens most often in children and can develop after a cold or other infection, or after a minor neck injury.
The main sign is a neck that stays tilted and cannot be straightened. Early diagnosis and treatment are very important.

1
Triggered by infection or minor injury

Upper respiratory infections, tonsillitis, minor neck bumps, or ENT surgery can be the cause

2
Inflammation develops in the upper neck joint

The tissues around the C1-C2 vertebrae become swollen due to inflammation

3
The joint locks in a twisted position

Inflammation causes the joint to stay displaced and unable to return to normal

👶 Children 🤧 After infection 💥 Minor injury 🏥 After surgery
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Neck is tilted and cannot be straightened
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Pain when moving the neck
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Head tilts one way while the face turns the other, and it won't come back
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Neck suddenly tilted after a cold
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Rest
Keep the neck still and wait for the inflammation to settle
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Cervical Collar
Mainly for mild cases seen soon after onset. A brace keeps the neck stable and supported
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Pain Relievers & Muscle Relaxants
Reduce pain and relieve muscle tension. They can cause drowsiness and unsteadiness, so do not drive or operate machinery while taking them
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Traction & Reduction
If a collar does not help, Glisson traction (continuous traction as an inpatient) or reduction under anesthesia is used
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Most children improve with conservative treatment

With early diagnosis and proper care, most cases improve with conservative treatment. However, the more time passes after onset, the harder it is to correct: children first seen more than a month after onset are reported to need surgery more often. Follow-up is also needed because recurrence is possible.

💡 If you notice your child's neck is tilted

  • See a doctor early if your child's neck tilts after a cold
  • Do not try to force the neck straight
  • The longer you wait, the harder it is to correct
  • If the neck tilt or pain lasts more than 2-3 days, we recommend visiting an orthopedic clinic
  • If there is a fever, a sore throat or trouble swallowing, or weakness in the arms or legs, do not wait and see — seek care right away