Unexpected death after occipital condylar fracture

Bulthuis, Vincent J; Cornips, Erwin M. J.; Dings, J.; Santbrink, Henk van; Postma, Alida A.

doi:10.1007/s00701-017-3165-5

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…OCF can be fatal or often diagnosed post mortem. Bell made the first description of OCF in 1817 during a post mortem examination [1,[12][13][14]. In all of our patients, head trauma and cervical spine injuries were found during the examination in the emergency department.…”

Section: Discussionmentioning

confidence: 68%

“…After confirming the satisfactory alignment of the injured bone fragments, the patients were discharged from the unit with the recommendation of a conscientious lifestyle and observation for the occurrence of distressing symptoms. The CT of cranio-cervical junction (CCJ) was performed in all patients at the end of the treatment, in patients treated with the halo-vest after 13 weeks (11)(12)(13)(14), and with the cervical collar after 11 (9)(10)(11)(12) weeks.…”

Section: Methodsmentioning

confidence: 99%

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

Tomaszewski

Kler²,

Pethe³

et al. 2021

J Orthop Surg Res

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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.

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Section: Discussionmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

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

Tomaszewski

Kler²,

Pethe³

et al. 2021

J Orthop Surg Res

View full text Add to dashboard Cite

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“…Some oligosymptomatic forms may exhibit mild to moderate cervical pain 17 , 18 . Yet, there are reports of catastrophic progression due to secondary injuries associated with the fracture, such as posterior fossa hematomas, which can produce brainstem compression syndromes or upstream obstructive hydrocephalus 19 . In addition, the involvement of other cervical structures is also described, as in cases with retropharyngeal hematomas 20 .…”

Section: Discussionmentioning

confidence: 99%

Observational study of patients with occipital condyle fracture at a brazilian referral trauma center

Batista

Aguiar

Bennett

et al. 2021

Rev. Col. Bras. Cir.

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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.

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“…However, these previous studies have not described the neurovascular integrity in their management decisions. Extra-axial hemorrhages at the craniocervical junction may result in fatal complications [7]. Therefore, adequate neurovascular evaluation and careful managements are necessary in avulsion OCF patients.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Avulsion fracture of the occipital condyle are rare lesion at craniovertebral junction. It is often related to high-energy traumatic injuries and show diverse clinical presentations. Neurologic deficit and instabilities may justify surgical treatment. However, the integrity of neurovascular structures is undervalued in the current literatures. In this case report, we described a 26-year-old female patient with avulsion fracture of occipital condyle following a traffic accident. On initial presentation, her Glasgow Coma Scale was 8. She presented with fracture compound comminuted depressed, on the left side of her forehead with skull base fracture extending into clivus and occipital condyle. Her left occipital condyle showed avulsion injury with displacement deep into the skull base. On her computed tomography angiography, the displaced occipital condyle compressed on the sigmoid sinus resulting in its obstruction. While she was recovering her consciousness during her stay in the hospital, the lower cranial nerves showed dysfunctions corresponding to Collet-Sicard syndrome. Due to high risk of vascular injury, the patient was conservatively treated for the occipital condyle fracture. On the 4 months postdischarge follow-up, her cranial nerve symptoms practically recovered, and the occipital condyle showed signs of fusion without further displacement. Current literatures focus on neurologic deficit and stability for the surgical decisions. However, it is also important to evaluate the neurovascular integrity to assess the risk of its manipulation as it may result in fatal outcome. This case shows, an unstable avulsion occipital condyle fracture with neurologic deficit can be treated conservatively and show a favorable outcome.

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Unexpected death after occipital condylar fracture

Cited by 3 publications

References 14 publications

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

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

Observational study of patients with occipital condyle fracture at a brazilian referral trauma center

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

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