A case of occipital condylar fracture in a multiply injured and unconscious motorcyclist is reported. This injury was clinically unsuspected but found on the lowest cuts of head computed tomography. It is shown that this site is often inadequately imaged when scanning the head and neck in victims of trauma. The Anderson and Montesano classification of occipital condylar fracture is described. It is noted that types 1 and 2 are stable injuries but type 3 is potentially unstable. A retrospective analysis of 30 head computed tomography scans in trauma cases revealed that in only 16 were the occipital condyles adequately imaged. It is emphasised that vigilance is required to detect fractures of the occipital condyle and that it should be standard practice to include this area when performing computed tomography of the head in trauma victims. (J Accid Emerg Med 2000;17:220-221) Keywords: occipital condyle; fracture; trauma Case report A 16 year old male road traYc accident victim was found lying beside his motorcycle with the helmet some distance away. The exact speed and circumstances of the incident were unclear. Paramedic roadside opinion was that the victim had suVered a tumbling fall with consequent potential for twisting head injury. In the prehospital phase a semirigid cervical collar was applied and fluid resuscitation given.On arrival at hospital the patient was haemodynamically stable with a Glasgow Coma Scale score of 9 and other than bleeding from an occipital scalp wound no external injury was seen. He was electively intubated and ventilated. Cervical spine control was maintained at all times. Fluid resuscitation was continued and initial radiographs revealed bilateral pulmonary contusions. Cervical spine plain films were normal.Immediate computed tomography of the head chest and abdomen was performed and a frontal lobe haematoma with mild cerebral oedema was seen. The lowermost head cuts revealed a displaced fracture of the right occipital condyle (fig 1). Ventilation was continued and ongoing care given by intensivists and the neurosurgical team. Intracranial pressure was monitored and remained normal. Halo traction was applied before his extubation on day four. He required three months rigid fixation in a halo vest. Follow up computed tomography showed healing at the fracture site without evidence of subluxation. Residual cognitive impairment at two weeks necessitated referral to the head injury rehabilitation unit and at the time of writing cognitive function and speech are now normal and a residual swallowing problem is improving constantly. DiscussionOccipital condylar fracture was originally described by Charles Bell in 1817.1 This was a postmortem diagnosis of a hospital patient who sustained a fall at the time of discharge! His demise was attributed to medullary compression by the condylar fragment. Before the wide availability of computed tomography diagnosis in life was rare but by 1996 61 cases had been reported in the literature. In addition other occipital condylar fractures foun...
We present a series of eight patients undergoing circumferential neural decompression and stabilization of the thoracolumbar spine via a single midline posterior approach, with complete vertebrectomy for a variety of indications. Four had primary tumours, two secondary tumours, one patient had tuberculosis and one had delayed deformity due to trauma. This single posterior approach is made possible via the use of an expandable cage that may be expanded in situ to offer anterior and middle column reconstruction. There were no major neurological complications and all patients with deficits improved postoperatively. Extensive posterior fixation was avoided with five patients undergoing a one above/one below fixation and three undergoing a two above/two below fixation. When combined with pedicle screw and rod fixation this anterior reconstruction makes a sound construct. The flexibility of this approach in the thoracolumbar spine, some of the biomechanical advantages and pitfalls are considered.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.