Occipital condylar fractures in children: rare or underdiagnosed?

Abstract

A 6-year-old female is described who sustained a fracture of the left occipital condyle after colliding with a car at low speed. The fracture was only visible on thin-slice CT of the neck, which is not routinely recommended in children following a road traffic accident. Fractures of the occipitoantlantoaxial complex are difficult to diagnose by plain radiography, and awareness of this problem needs to be raised among clinicians treating children. Dentomaxillofacial Radiology (2012) 41, 175-176. doi: 10.1259/dmfr/59348986Keywords: children; head injury; occipital condylar fracture; paediatrics Case reportA 6-year-old female trying to cross a road was hit on the left side of the body by a car travelling at a speed of around 20 mph. She did not lose consciousness and stood up by herself. Her mother, who had witnessed the incident from a distance, drove her in her own car to the local casualty department. On arrival she was assessed by a senior house officer and a registrar. She had a short period of anterograde amnesia and complained of nausea and neck pain on the left side. No imaging studies were requested but the child was admitted to the paediatric ward for observation. On the consultant ward round the next morning she complained of pain in the midcervical spine on palpation. She showed abrasions and bruises above the left eye, on the left cheek bone, the right hip and the lower back. A CT of the cervical spine was arranged, which revealed a fracture of the left occipital condyle and of the left occipital bone (Figure 1). No abnormality was seen on a plain lateral radiograph (Figure 2). After discussion with a neurosurgeon it was decided to treat the patient conservatively with a soft collar for 8 weeks. A repeat CT scan 1 week later showed signs of healing and no displacement of the bone fragment. DiscussionThe occipital condyles are two prominences located on the undersurface of the skull on either side of the foramen magnum. Together with the atlas and axis

Occipital Condyle Fractures in Adolescents

“…Mean follow-up period was 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months. The occipital condyle fracture was not an isolated injury in any of the patients.…”

“…Wy da je nam się, że MR po wi nien być wy ko na ny ja ko ba da nie uzu peł nia ją ce TK u wszyst kich pa cjen tów, nie tyl ko w przy pad ku ist nie ją cych cech in kon gru en cji C0-C1 -C2. Ist nie ją dwa po wszech nie uży wa ne sys te my klasy fi ka cji w/w zła mań, wg An der son-Mon te sa no oraz wg Tu li et al [1,3,8,[11][12][13][14][15][16]. Po dział An der son-Monte sa no wy ró żnia trzy ty py zła mań.…”

“…We believe that MRI should supplement CT in all patients, not only those with signs of incongruency at C0-C1-C2. Two systems: one developed by Anderson and Montesano and one developed by Tuli et al, are commonly used to classify occipital condyle fractures [1,3,8,[11][12][13][14][15][16]. The Anderson-Montesano classification lists three types of fractures.…”

Vaikų Skeleto Radiologinių Tyrimų Specifiniai Aspektai: Literatūros Apžvalga

“…Dažniausi kaklinės stuburo dalies pažeidimo simptomai yra skausmas ir torticollis. Pradinis radiologinis tyrimas rentgenografinis, tačiau išliekant klinikiniams simptomams, indikuotina kompiuterinė tomografija, o įtariant nugaros smegenų, nervinių šaknelių pažeidimą, -magnetinis rezonansas [33,34]. Vertinant vaikų kaklinės stuburo dalies radiologinius vaizdus, svarbu žinoti normos variantus.…”

Fratura de côndilos occipitais

“…Essa afecção é mais prevalente em indivíduos do sexo masculino, tendo sido descrita em idades que variam desde os 6 aos 82 anos, no entanto a grande maioria dos doentes situa-se entre os 20 e 40 anos de idade. 1,6 No passado, as FCO foram consideradas bastante raras por causa de sua difícil detecção com radiografia convencional. A primeira evidência radiográfica de uma FCO in vivo foi relatada em 1962, enquanto as primeiras tomografias computadorizadas (TC) foram publicadas em 1983.…”