Occipital Condyle Fractures

Czech version

Authors: J. Kočiš; M. Kelbl
Authors‘ workplace: Klinika traumatologie LF MU a Úrazová nemocnice Brno
Published in: Cesk Slov Neurol N 2013; 76/109(6): 728-731
Category: Short Communication

Overview

Introduction:
Fractures of the occipital condyle are rare injuries. Recently, organization of pre‑hospital care improved and diagnostic algorithms for an examination of patients with an injury of the head and/ or cervical spine were introduced, so the detection of this type of injury increased. The mechanism of injury is usually a high‑speed car crash or fall on the head from height.

Material and method:
This was a prospective study. Since 2004, we examined injured cervical spine in all symptomatic patients with spiral CT of C0 to T2. Each occipital condyle fracture was classified according to Anderson and Montesano and then also according to Tuli. We recorded patients’ age, sex, mechanism of injury, type of injury, neurological image and the range of motion after therapy. Patients were followed up for three months. Bone healing was confirmed on the basis of a CT examination.

Results:
From 2004 to the end of 2012, we admitted 14 patients diagnosed with occipital condyle fracture. The diagnosis was based on CT scans and multiplanar reconstructions. Twelve patients were included in the study. The mean age was 37.4 years. The right condyle was injured three times and the left condyle nine times. We diagnosed a paresis of the 12^th cranial nerve once. Other patients were free of neurological symptoms. In all patients, we proceeded in a conservative way with good results.

Conclusion:
CT scans and multiplanar reconstruction are needed to identify a fracture of the occipital condyle. A Philadelphia collar or a halo fixation apparatus are sufficient for the therapy. When craniocervical instability is identified, occipital cervical stabilization is required.

Key words:
cervical spine injury – occipital condyle fractures

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Anderson PA, Montesano PX. Morphology and Treatment of Occipital Condyle Fractures. Spine 1988; 13(7): 731−736.

2. Demisch S, Lindner A, Beck R, Zierz S. The Forgotten condyle: Delayed hypoglossal nerve palsy caused by fracture of the occipital condyle. Clin Neurol Neurosurg 1998; 100(1): 44−45.

3. Desai SS, Coumas JM, Danylevich A, Hayes E, Dunn EJ.Fracture of the Occipital Condyle: Case Report and Review of the Literature. J Trauma 1990; 30(2): 240−241.

4. Leventhal MR, Boydston WR, Sebes JI, Pinstein ML, Watridge CB, Lowrey R. The diagnosis and treatment of fractures of the occipital condyle. Orthopedics 1992; 15(8): 944−947.

5. Mody BS, Morris EW. Fracture of the occipital condyle: case report and review of the world literature. Injury 1992; 23(5): 350−352.

6. Noble ER, Smoker WR. The forgotten condyle: the appearance, morphology, and classification of occipital condyle fractures. AJNR Am J Neuroradiol 1996; 17(3): 507−513.

7. Spencer JA, Yeakley JW, Kaufman HH. Fracture of the occipital condyle. Neurosurgery 1984; 15(1): 101−103.

8. Lam CH, Stratford J. Bilateral hypoglossal nerve injury with occipital condylar fracture. Can J Neurol Sci 1996; 23(2): 145−148.

9. Legros B, Fournier P, Chiaroni P, Ritz O, Fusciardi J.Basal fracture of the skull and lower (IX, X, XI, XII) cranial nerves palsy: four case report including two fractures of the occipital condyle – a literature review. JTrauma 2000; 48(2): 342−348.

10. Bell C. Surgical Observations. Middlesex Hosp J 1817; 4: 469−470

11. Bloom AI, Neeman Z, Floman Y, Gomori J, Bar- Ziv J.Occipital condyle fracture and ligament injury: imaging by CT. Pediatr Radiol 1996; 26(11): 786−790.

12. Bloom AI, Neeman Z, Slasky BS, Floman Y, Milgrom M, Rivkind A et al. Fracture of the occipital condyles and associated craniocervical ligament injury: incidence, CT imaging and implications. Clin Radiol 1997; 52(3): 198−202.

13. Hanson JA, Deliganis AV, Baxter AB, Cohen WA, Linnau KF, Wilson AJ et al. Radiologic and clinical spectrum of occipital condyle fractures. AJR Am J Radiol 2002; 178(5): 1261−1268.

14. Link TM, Schuierer G, Hufendiek A, Horch C, Peters PE. Substantial head trauma: value of routine CT examination of the cervicocranium. Radiology 1995; 196(3): 741−745.

15. Leone A, Cerase A, Colosimo C, Lauro L, Puca A, Marano P. Occipital condylar fractures: a review. Radiology 2000; 216(3): 635−644.

16. Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Neurosurgery 1997; 41(2): 368−377.

17. Jones DN, Knox AM, Sage MR. Traumatic avulsion fracture of the occipital condyles and clivus with associated unilateral atlantooccipital distraction. AJNR Am J Neuroradiol 1990; 11(6): 1181−1183.

18. Maserati MB, Stephens B, Zohny Z, Lee JY, Kanter AS, Spiro RM et al. Occipital condyl fractures: clinical decision rule and surgical managment. J Neurosurg Spine 2009; 11(4): 388−395.

19. Bozkurt G, Hazer B, Yaman ME, Akbay A, Akalan N. Isolated paralysis of glossopharyngeal and vagus nerve associated with type II occipital condyle fracture: case report. Childs Nerv Syst. 2010; 26(5): 719−722.

20. Mueller FJ, Fuechtmeier B, Kinner B, Rosskopf M, Neumann C, Nerlich M et al. Occipital condyle fractures. Prospective follow‑up of 31 cases within 5 years at a level 1 trauma centre. Eur Spine J 2012; 21(2): 289−294.

21. Mann FA, Cohen W: Occipital condyle fracture: significance in the assessment of occipitoatlantal stability. AJR Am J Roentgenol 1994; 163(1): 193−194.