High cervical pain and impairment of skull mobility as the only symptoms of an occipital condyle fracture. Case report

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.

Nonoperative treatment of occipital condyle fractures: an outcomes review of 32 fractures

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

To evaluate the outcomes of patients with occipital condyle fractures (OCFs) treated nonoperatively and establish factors associated with neck disability.

SUMMARY OF BACKGROUND DATA

The majority of OCFs are treated nonoperatively; however, few studies have reported long-term functional outcomes of these patients.

METHODS

From 1999 to 2007, 103 patients with OCFs were identified. Of this cohort, 28 patients with 32 fractures met the inclusion criteria. Fracture and patient characteristics, including patient age and sex, Anderson and Montesano fracture type, bilaterality, associated head injury, and fracture displacement, were noted. The Neck Disability Index (NDI) was calculated at final follow-up.

RESULTS

Anderson and Montesano type III fractures were the most commonly observed (54%), followed by type II (43%). The mean NDI was 14.0, which correlates with mild disability, and the NDI headache question showed the highest mean disability score of all questions. There was no statistically significant association between NDI scores and fracture type, displacement of fracture, sex, bilaterality, or presence of head injury. Age was associated with NDI scores, with age range of 40 to 60 years having a mean NDI score of 24.3.

CONCLUSION

Anderson and Montessano types I, II, and III OCFs may be treated nonoperatively in the absence of ligamentous instability and concomitant cervical injuries with the expectation of mild neck disability regardless of the displacement, bilaterality, sex, or presence of head injury. Greater disability may be expected in patients aged between 40 and 60 years than in other ages.

Occipital condyle fractures

OBJECTIVE

The anatomy, clinical presentation, radiologic evaluation, treatment, and outcome of occipital condyle fractures are reviewed.

METHODS

We review and discuss the literature on occipital condyle fractures.

RESULTS

Occipital condyle fractures are best diagnosed with computed tomography. The neurologic presentation is variable. The majority of these injuries may be treated nonoperatively, but an occipitocervical fusion is necessary to restore stability across the craniovertebral junction.

CONCLUSION

Occipital condyle fractures are a rare but serious injury that requires prompt diagnosis and treatment.

Unilateral occipital condylar fracture presenting as neck pain and restriction of neck movements- Report of a case and review of literature

Occipital condylar fractures (OCFs) once rare injuries are not so at present. A young male, victim of motor vehicle accident, presented with severe high cervical pain and restriction of neck movements without any focal neurological deficit, with normal cervical spine x-rays and computerized tomography (CT) scans brain. CT scan and magnetic resonance (MR) imaging of the craniovertebral junction (CVJ) area revealed a retro-pulsed segment in the cervical spinal canal with no cord compression or ligament injury. Patient improved with immobilization of neck. Patients with severe high cervical pain and restricted head movements OCF should be suspected and patient should be evaluated further. Majority of stable OCF improve with immobilization only.

Occipital condyle fracture in a victim of a motor vehicle collision

Occipital condyle fractures are rarely reported in the Emergency Medicine literature. It is unclear whether these fractures are rare or under-diagnosed. Occipital condyle fractures are associated with high-energy blunt trauma with significant cranial-cervical torque or axial loading. We report a case of a female patient with an occipital condyle fracture. The patient only complained of shoulder pain, but was found to have high cervical spine tenderness, after a moderate-speed front-end motor vehicle collision. Initial cervical spine radiographs were non-diagnostic. Computed tomography of the cervical spine demonstrated a non-displaced occipital condyle fracture. Conservative management with a semi-rigid cervical collar was successful in treating this patient's fracture. A review of the literature covers the diagnosis, radiographic findings, and management of this fracture.

Occipital condylar fractures. Review of the literature and case report

Fractures of the occipital condyle are rare. Their prompt diagnosis is crucial since there may be associated cranial nerve palsies and cervical spinal instability. The fracture is often not visible on a plain radiograph. We report the case of a 21-year-old man who sustained an occipital condylar fracture without any associated cranial nerve palsy or further injuries. We have also reviewed the literature on this type of injury, in order to assess the incidence, the mechanism and the association with head and cervical spinal injuries as well as classification systems, options for treatment and outcome.

Occipital condyle fractures: report of five cases and literature review

Occipital condyle fractures (OCFs) are uncommon and potentially fatal lesions. After the advent of CT, prompt diagnosis can be readily made and consequently better prognosis of these patients is expected. Early recognition of some types of OCF is imperative to avoid fatal results. We analyzed 121 cases of OCF (116 from the literature and five of our own). Rarely patients with a deficit of the lower cranial nerves make a complete recovery. However, quoad vitam prognosis of patients with "pure OCFs" remains good. Immobilization provides good recovery of most OCFs, but delay of treatment can lead to serious morbidity. We want to emphasize that not only an OCF with instability of O-C1-C2 can be a fatal injury unless prompt surgical intervention, but a displacement and migration of the fractured condylar fragment can also result in a fatal outcome. A high level of suspicion is fundamental for the early diagnosis of these fractures, so that when a posterior basal cranial or occipital squama fracture occurs, a CT study of the occipital condyles becomes imperative.

Delayed hypoglossal palsy following occipital condyle fracture--case report

Occipital condyle fractures are rare. When present, they produce lower cranial palsies and/or brainstem dysfunction. A 32 year old man sustained multiple injuries. At the time of admission the patient had no neurological deficits. Three weeks after the accident, the patient complained of slurring of speech. Clinical examination revealed an isolated hypoglossal palsy. Radiological evaluation revealed an occipital condyle fracture. The patient was treated with a rigid collar. Eighteen months after the injury, the patient noted slight improvement in his speech. However, clinical examination showed a persistent hypoglosssal palsy. Occipital condyle fractures are rare. They may be associated with lower cranial nerve palsies. As demonstrated by this case, this entity should be included in the differential diagnosis of hypoglossal palsy. Since occipital condyle fractures can exist without neurological deficits, special attention should be paid to imaging of the craniovertebral junction in patients with head injury.

Occipital condyle fractures

DIAGNOSTIC

STANDARDS

There is insufficient evidence to support diagnostic standards.

GUIDELINES

Computed tomographic imaging is recommended for establishing the diagnosis of occipital condyle fractures. Clinical suspicion should be raised by the presence of one or more of the following criteria: blunt trauma patients sustaining high-energy craniocervical injuries, altered consciousness, occipital pain or tenderness, impaired cervical motion, lower cranial nerve paresis, or retropharyngeal soft tissue swelling.

OPTIONS

Magnetic resonance imaging is recommended to assess the integrity of the craniocervical ligaments.

TREATMENT

STANDARDS

There is insufficient evidence to support treatment standards.

GUIDELINES

There is insufficient evidence to support treatment guidelines.

OPTIONS

Treatment with external cervical immobilization is recommended.

Occipital condylar fractures: a review

The purpose of this review article is to summarize the epidemiology, pertinent anatomy, mechanisms of injury, and classification systems of occipital condylar fractures (OCFs), as well as their clinical presentation and screening, the importance of computed tomography (CT) for detection, and current treatment options. The authors emphasize the rate of occurrence of OCFs, which may be detected in as many as 16% of patients with craniocervical injury. Clinical presentation is not specific, and OCF is not readily diagnosed at physical examination. Failure to diagnose may result in substantial morbidity, and thus accurate diagnosis is mandatory for both therapeutic and medicolegal implications. The diagnosis is most likely to be made with CT. Thin-section CT technique is the method of choice to evaluate the traumatized craniocervical junction. OCFs should be suspected in all patients sustaining high-energy blunt trauma to the head and/or upper cervical spine, resulting from axial loading, lateral bending and/or rotation, and/or direct blow. Besides a CT study assessing potential intracranial injuries, these patients require CT of the craniocervical junction. Radiologists should be aware of the types of OCFs and associated injuries.

Unusual occipitoatlantal fracture dissociation with no neurological impairment. Case report

The authors describe an unusual case of a complex traumatic fracture-dissociation injury of the craniovertebral junction, which the patient survived with no neurological damage. This case featured the rare combination of an avulsion of both the right occipital condyle and clivus and a fracture of the left lateral mass of the atlas. Because of the craniocervical ligament injury and the slight anterior occipitoatlantal dislocation, the lesion was considered to be unstable and was treated successfully with a cervical collar. The authors emphasize that thin-slice computerized tomography scanning with multiplanar reconstructions is essential to visualize these fractures, whereas magnetic resonance imaging is useful to assess soft tissues.

Occipital condyle fractures

OBJECTIVE

Occipital condyle fractures (OCFs) are infrequently recognized. Three recent cases of OCF in our center prompted a review of the incidence, clinical presentation, diagnosis, and treatment of this entity.

METHODS

A retrospective review of medical records and radiographic results was performed for 93 of 316 consecutive patients who were victims of trauma, who presented at the Toronto Hospital during a 13-month period, and who had undergone computed tomography of the occiput.

RESULTS

A review of the literature regarding OCF revealed that cranial nerve deficits occurred in 31% of the patients with OCFs; of those, the deficits were delayed in 38%. Three new cases of OCF, with neck pain but without cranial nerve deficits, have been reported. The cervical spine x-rays revealed nothing abnormal in 96% of the reported cases. In our retrospective review, asymptomatic OCF was revealed by computed tomography for 1 of the 93 patients.

CONCLUSION

OCF is a diagnostic challenge. We suggest that computed tomographic scans of O-C2 be obtained in the following circumstances: presence of lower cranial nerve deficits, associated head injury or basal cranial fracture, or persistent severe neck pain despite normal radiographic results. We propose a new classification system for the management and treatment of OCF based on the stability of the O-C1-C2 joint complex reflected by the presence of displacement of the condyle, computed tomographic or radiographic evidence of O-C1-C2 instability, and magnetic resonance evidence of ligamentous injury. OCFs are divided into the following types: Type 1 (stable), undisplaced fracture; Type 2A (stable), displaced fracture with no ligamentous instability; and Type 2B (unstable), displaced fracture with ligamentous instability.

Fracture of the occipital condyles and associated craniocervical ligament injury: incidence, CT imaging and implications

Thin section contiguous axial computer tomography (CT) was used to demonstrate fractures of the occipital condyle and craniocervical ligament injury. During a 12-month period, 55 consecutive patients who had sustained high energy blunt trauma to the head or upper cervical region were examined (38 male and 17 female, age range 3-80 years, median 24 years). If occipital condyle fracture was suspected clinically, CT was performed from C2 to the foramen magnum with two dimensional sagittal, coronal, and curvilinear reconstructions and employing bone and soft tissue windows. Occipital condyle fractures were classified according to Anderson and Montesano types 1, 2 or 3. Injury to the internal craniocervical ligaments was described. Nine of 55 patients had occipital condyle fractures (16.4%). Injury of the alar ligaments was demonstrated in four and tectorial membrane injury in two patients. Three of the nine patients had associated fractures of cervical vertebrae. Five of nine patients had a normal Glasgow coma scale on admission (55%) and in two patients the occupital condyle fracture was the only significant injury. Plain cervical radiographs were non-diagnostic. Two patients had significant pain and limited motion of the craniocervicum several months following injury. In conclusion, CT should be performed where there is a high clinical suspicion of occipital condyle fracture, that is based mainly on the mechanism of injury.

Occipital condyle fracture and ligament injury: imaging by CT

The true incidence of fracture of the occipital condyles is unknown. It may be associated with instability at the craniocervical joint. CT is the modality of choice for the demonstration of these fractures, but its use for imaging of the associated ligament injury has not been reported. In order to demonstrate normal anatomy, occipital condyle fracture and ligament injury, and to estimate the incidence of this lesion, 21 children and young adults with high-energy blunt craniocervical injury were examined prospectively. Thin-slice, axial, contiguous, CT was performed from the base of C2 to above the foramen magnum. Bone and soft tissue windows and coronal, sagittal, and curvilinear 2D reconstructions were performed. Five occipital condyle fractures were identified in four patients (19 %), with demonstration of alar ligament injury in two cases and local hematoma in one. In four, artifacts or rotation precluded assessment of ligaments. In all remaining cases normal bone and ligament anatomy was demonstrated. Fracture of the occipital condyles following craniocervical injury is not uncommon in children and young adults. Normal bone and ligament anatomy and pathology can be safely and clearly demonstrated in seriously injured patients and others using this CT technique. Increased awareness of this entity and a low threshold for performing CT should avoid the potentially serious consequences of a missed diagnosis.