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

Abstract

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.

Occipital condyle fracture in the pediatric population: A management algorithm and systematic review

“…Notably, while these findings were described in a majority adult population, these established measurements can largely be applied to the population included in this review as the majority sustained their injury during or after puberty. 23 …”

Management of a traumatic avulsion fracture of the occipital condyle in polytrauma patient in Korea: a case report

“…Nevertheless, we have closely observed her for delayed onset of possible venous infarction of the brain with serial brain CT scans. Currently, the Anderson-Montesano and the Tuli classifications are commonly used mainly to assess the stability of the OCFs [13], but the integrity of the vasculature is incorporated into the classification. For the surgical decision making it is also important to consider vascular work-up in addition to the usual workup to assess stability, alignment, and neurologic deficit.…”