Immobilisation in occipital condyle fractures: A systematic review

Clinical Diagnosis and Treatment of 43 Cases of Occipital Condylar Fractures: A Single-Center Retrospective Study

OBJECTIVE

This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and classification.

METHODS

A retrospective analysis was conducted on 43 patients with OCFs who were admitted to our neurosurgery center between 2017 and 2023.

RESULTS

The investigation covered their clinical symptoms, CT scan results, and treatment outcomes. It was found that 25.6% of the patients suffered from severe craniocerebral injuries with Glasgow Coma Scale (GCS) scores of 3-8 points, 9.3% had moderate injuries with GCS scores of 9-12 points, and 65.1% exhibited mild injuries with GCS scores of 13-15 points. Of these patients, 90.7% showed improvement upon discharge, 4.7% succumbed to their injuries, and another 4.7% developed paraplegia. Symptoms indicative of OCF in individuals with CCJ injuries included neck pain, swelling, cranial nerve palsy, and posterior pharyngeal wall swelling. Frequently observed complications in OCF patients included cerebral contusion, occipital bone fractures, and skull base fractures. Employing thin-layer CT scans of the CCJ area, along with sagittal and coronal CT reconstructions, is essential for identifying OCFs. The fractures were classified into 3 types based on the Anderson-Montesano classification, which, when modified, provides enhanced treatment guidance.

CONCLUSIONS

OCFs are predominantly present in cases of high-energy trauma, with high-resolution thin-layer CT scans serving as the preferred diagnostic method. The application of the modified Anderson-Montesano classification, distinguishing between stable and unstable fractures, facilitates the determination of suitable treatment strategies. Stable OCFs can be managed using a rigid neck brace, while unstable OCFs may require Halo-vest frame fixation or surgical intervention.

Major traumatic injury sustained during use of a virtual reality (VR) headset

We report the first documented case of significant, potentially life-changing trauma sustained during use of virtual reality (VR). A male in his fifties fell from standing whilst immersed in a VR game and sustained injuries including bilateral occipital condyle fractures, spinal cord contusion resulting in central cord syndrome, right vertebral artery occlusion, and left hypoglossal nerve palsy. His injuries were managed conservatively with a lengthy recovery period. The patient made a good recovery with full resolution of his symptoms and has returned to full-time employment. This case discusses how these injuries are commonly related and considers the implications of VR on a person’s balance and whether the headset may make neck extension injuries more likely.

Observational study of patients with occipital condyle fracture at a brazilian referral trauma center

OBJECTIVE

to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America.

METHODS

this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center.

RESULTS

a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was the main determinant for negative outcomes.

CONCLUSION

the findings of this study are in accordance with available literature data. The use of external stabilization with a cervical collar is reinforced for the treatment of stable lesions, even when these are bilateral. Assessment of the patients' follow-up results in the studied sample may contribute with useful information for the treatment of occipital condyle fractures.

Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

Background:

Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution.

Methods:

This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma.

Results:

The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment.

Conclusion:

Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.

Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures

Background

Occipital condyle fractures (OCFs) in patients before 18 years of age are rare. Classifications of OCF are based on the CT images of the cranio-cervical junction (CCJ) and MRI. The Anderson-Montesano and Tuli classifications are the types which are most commonly used in these cases. Classification of OCFs allows the implementation of OCF treatment. The aim of this study was to evaluate the effectiveness of using the OCF classification in pediatric patients based on the analysis of our own cases.

Methods

During the years 2013–2020, 6 pediatric patients with OCFs, aged 14–18, have been treated. Two patients with unstable fracture III according to Anderson-Montesano and IIB according to Tuli were treated with the halo-vest. Additionally, one patient presenting neurological symptoms and with an associated C1 fracture was qualified for the halo-vest stabilization as well. The other patients were treated with a Minerva collar. We evaluated the results 6 months after completing the OCF treatment using the Neck Disability Index (NDI) and SF-36 questionnaires. Confidence intervals for the mean values were verified using the MeanCI function (from the R library DescTools) for both classical and bootstrap methods.

Results

Based on NDI results, we have obtained in our patients an average of 4.33/45 points (2–11) and 9.62% (4.4–24.4). Based on the SF-36 questionnaire, we obtained an average of 88.62% (47.41–99.44).

Conclusion

The Anderson-Montesano and Tuli’s classifications of OCF can be used to assess the stability of OCF in adolescents, but both classifications should be used simultaneously. CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF.

Upper Cervical Spine Trauma: WFNS Spine Committee Recommendations

Craniovertebral junction (CVJ) trauma is a challenging clinical condition. Being a highly mobile functional unit at the junction of the skull and the vertebral column, traumatic events in this area may produce devastating neurological complications and death. Additionally, many of the CVJ traumatic injuries can be left undiagnosed or even raise difficult treatment dilemmas. We present a literature review in the format of recommendations on the diagnosis and management of different scenarios for upper cervical trauma and produce recommendations, which can be applicable to various areas of the globe.

Clinical relevance of occipital condyle fractures

Context:

No consensus about classification, treatment, and clinical relevance of occipital condyle fractures (OCFs) exists.

Aims:

The aim of the study was to determine radiological, clinical, and functional outcome of OCFs and thereby determine its clinical relevance.

Settings and Design:

This was a retrospective analysis of a prospective follow-up study.

Materials and Methods:

From May 2005 to May 2008, all OCFs were included from a Level-1 trauma center. Patient files were reviewed for patient and fracture characteristics. Fracture classification was done according to the Anderson criteria. Clinical outcome was assessed by completing two questionnaires, radiological outcome by computed tomography imaging, and functional outcome by measuring active cervical range of motion using a Cybex EDI-320.

Statistical Analysis Used:

A Fisher's exact Test was used in categorical variables and a one-sample t-test for comparing means of active cervical range of motion in occipital fracture patients with normal values. An independent samples t-test was carried out to compare the means of groups with and without accompanying cervical fractures for each motion.

Results:

Thirty-nine patients were included (4 type I, 16 type II, and 19 type III). Twenty-seven patients completed follow-up, of whom 26 were treated conservatively. Fracture healing was established in 25 of 28 fractures at a median follow-up of 19 months. Eleven patients had none to minimal pain or disability at follow-up, 12 had mild, and two had moderate pain or disability on questionnaires. No statistically significant difference in active cervical range of motion was identified comparing means stratified for accompanying cervical fractures.

Conclusions:

Conservatively treated patients with an OCF generally show favorable radiological and clinical outcome.