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

Occipital condyle fractures (OCF) are seldom described in children, with only 14 cases reported in the literature. We report the observation of a 13-year-old child in whom such a fracture was diagnosed. A review of the paediatric cases allowed us to identify the clinical features of OCF in children. The average age was found to be 10 years, and the causative traumatism was most often related to road traffic or sporting accidents with associated head injury. The level of consciousness was depressed in 67% of the cases, and in 53%, an injury to the cranial nerves, brain stem or high spinal cord was present. Neck pain with reduction of head mobility was reported in 27% of the cases. Treatment was generally conservative, i.e. a hard collar or halo vest for an average of 8 weeks. The course was favourable with respect to osseous consolidation, mobility and pain. On the other hand, the neurological deficits improved, but sequelae remained. Early diagnosis and treatment is mandatory since the secondary displacement of fractured fragments can injure the cranial nerves in a delayed fashion or even be fatal due to compression of the brain stem.

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“…However, it is probable that the prevalence of OCF is underestimated, because their diagnosis can be missed [9]. …”

Section: Discussionmentioning

confidence: 99%

“…They are even rarer in the child [1], and to our knowledge, only 14 cases of OCF in children are reported in the literature [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. The clinical relevance of these fractures has been recognised since Anderson and Montesano [2]classified them.…”

Section: Introductionmentioning

confidence: 99%

Occipital Condyle Fractures in Children

et al. 2003

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“…39 Often difficult to identify based on plain radiographs alone, OCFs are now diagnosed more frequently due to the widespread use of CT in the standard trauma evaluation. 6,41 Occipital condyle fractures have typically been associated with lower cranial nerve palsies, particularly hypoglossal nerve injury. Of primary concern, however, is the potential of OCFs to destabilize the CCJ.…”

mentioning

confidence: 99%

Occipital condyle fractures: clinical decision rule and surgical management

Maserati¹,

Stephens

Zohny

et al. 2009

SPI

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Object Occipital condyle fractures (OCFs) are rare injuries and their treatment remains controversial. Several classification systems have been proposed, first by Anderson and Montesano and more recently by Tuli and colleagues and Hanson and associates, who sought to stratify these fractures in a manner that would guide treatment that has typically ranged from semirigid collar immobilization to halo fixation or occipitocervical fusion. It has been the authors' impression, based on experience with OCFs at their institution, that classification is cumbersome and contributes little to the clinical decision-making process, while the identification of craniocervical misalignment and neural element compromise is paramount, and sufficient, for the planning of treatment. Methods The authors performed a retrospective review of 24,745 consecutive trauma presentations to a single Level I trauma center (UPMC Presbyterian Hospital) over a 6-year period, identifying 100 patients with 106 OCFs. All patients were evaluated by the spine trauma service and underwent imaging of the craniocervical junction using reconstructed CT scans. Patient characteristics, fracture characteristics (including fracture classification according to the 2 major classification systems), initial management, and status at follow-up were recorded. Results The incidence of OCF in this trauma population was 0.4%. Two patients had evidence of craniocervical misalignment on reconstructed CT imaging at the time of admission; both patients underwent occipitocervical fusion. One patient underwent occipitocervical fusion for unrelated C1–2 fractures. The remainder of those surviving to discharge, whose fractures represented all fracture subtypes, received treatment with a rigid cervical collar or counseling alone. No patients, including 4 patients with bilateral OCFs, were found to have developed delayed craniocervical instability or misalignment on follow-up, or to require further neurosurgical intervention for an OCF. Neural element compression was not identified in any of the patients, and there were no cases of delayed cranial neuropathy. Conclusions Beyond the identification of craniocervical misalignment on reconstructed CT scans at admission, further classification of OCFs is unnecessary. Management should consist of up-front occipitocervical fusion or halo fixation in cases demonstrating occipitocervical misalignment, or of immobilization in a rigid cervical collar followed by delayed clinical and radiographic evaluation in a spine trauma clinic if misalignment is not present.

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“…Cortes finos (1,2mmx1mm) permitem ótimo estudo de morfologia óssea e ligamentar, além de permitir excelente reconstrução tridimensional. 15 O tratamento conservador das fraturas de côndilo occipital evolui com bons resultados, ficando o paciente livre da dor cervical e mantendo o arco total de movimento do segmento envolvido após três meses de tratamento. Preconizam-se o uso de colar tipo Philadelphia para casos classificados como do tipo I e II de Anderson e Montesano, 7 e uma imobilização mais rígida, como halo gesso ou gesso Minerva pra as fraturas classificadas como tipo III, cabendo ainda o tratamento cirúrgico em casos de instabilidade persistente.…”

Section: Discussionunclassified

Fraturas do côndilo occipital: atualização da experiência em nosso serviço e revisão da literatura

et al. 2013

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RESUMOApresentamos neste trabalho a casuística de fraturas de côndilo occipital diagnosticada e tratada em nosso serviço nos últimos 10 anos. O presente estudo dá continuidade ao levantamento epidemiológico já realizado no período de 1993 a 2000. No período de 2001 a 2011, foram diagnosticados seis casos de fraturas de côndilo occipital e todos eles foram tratados de forma conservadora, exceto um, no qual se colocou um halo craniano inicialmente. Nos cinco casos tratados de modo conservador, observaram-se bons resultados, com estabilidade do segmento nas radiografias funcionais, ausência de limitação de movimento e ausência de dor. O paciente que foi tratado com halo apresentava tetraplegia parcial FRANKEL C e fraturas associadas (C5, C6, L1 e L2) e não apresentou melhora do quadro neurológico, verificando-se limitação do movimento cervical. Destacamos ainda a importância da investigação ativa de lesões na transição occipitocervical, principalmente nos casos decorrentes de trauma de alta energia, pois além das implicações clínicas da detecção precoce da fratura, o melhor emprego dos exames subsidiários tem sido um fator relevante para o aumento da incidência de fraturas do côndilo occipital. Como é historicamente relatado, o tratamento conservador ainda é eficaz e com baixo índice de complicações, e o tratamento cirúrgico deve ser indicado em casos com instabilidade definida.Descritores: Osso occipital; Traumatismos craniocerebrais; Humanos. ABSTRACTWe present a series of occipital condyle fractures diagnosed and treated in our hospital during the past 10 years. The present study continues an epidemiologic survey already performed in the period 1993 -2000 . From 2001 to 2011

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

Cited by 69 publications

References 9 publications

Occipital Condyle Fractures in Children

Occipital Condyle Fractures in Children

Occipital condyle fractures: clinical decision rule and surgical management

Fraturas do côndilo occipital: atualização da experiência em nosso serviço e revisão da literatura

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