Atlanto-axial rotatory fixation is a rare abnormality of the atlanto-axial joint characterised by a fixed rotated atlanto-axial joint. Duration of symptoms is the best predictor of those cases that ultimately require surgical fixation. We report 6 cases of atlanto-axial rotatory fixation that were treated at the Royal National Orthopaedic Hospital between 1998 and 2005. Diagnosis was confirmed by CT scan in all cases. The mean duration of symptoms was 8 weeks. 4 cases were reduced with halo traction, for between 7–28 days (mean 15 days), and 2 cases were reduced under anaesthesia. This was followed by application of a halo jacket in all 6 cases for between 6–12 weeks (mean 7.2 weeks). There was no significant recurrence with a mean duration of follow up 24 months. This rare series demonstrates late presenters of AARF responding favourably to non surgical intervention.