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Zhang Q, Zhang Y, Meng W, Zhao Y, Zhang J. Clinical Diagnosis and Treatment of 43 Cases of Occipital Condylar Fractures: A Single-Center Retrospective Study. World Neurosurg 2024; 185:e1086-e1092. [PMID: 38490441 DOI: 10.1016/j.wneu.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and classification. METHODS A retrospective analysis was conducted on 43 patients with OCFs who were admitted to our neurosurgery center between 2017 and 2023. RESULTS The investigation covered their clinical symptoms, CT scan results, and treatment outcomes. It was found that 25.6% of the patients suffered from severe craniocerebral injuries with Glasgow Coma Scale (GCS) scores of 3-8 points, 9.3% had moderate injuries with GCS scores of 9-12 points, and 65.1% exhibited mild injuries with GCS scores of 13-15 points. Of these patients, 90.7% showed improvement upon discharge, 4.7% succumbed to their injuries, and another 4.7% developed paraplegia. Symptoms indicative of OCF in individuals with CCJ injuries included neck pain, swelling, cranial nerve palsy, and posterior pharyngeal wall swelling. Frequently observed complications in OCF patients included cerebral contusion, occipital bone fractures, and skull base fractures. Employing thin-layer CT scans of the CCJ area, along with sagittal and coronal CT reconstructions, is essential for identifying OCFs. The fractures were classified into 3 types based on the Anderson-Montesano classification, which, when modified, provides enhanced treatment guidance. CONCLUSIONS OCFs are predominantly present in cases of high-energy trauma, with high-resolution thin-layer CT scans serving as the preferred diagnostic method. The application of the modified Anderson-Montesano classification, distinguishing between stable and unstable fractures, facilitates the determination of suitable treatment strategies. Stable OCFs can be managed using a rigid neck brace, while unstable OCFs may require Halo-vest frame fixation or surgical intervention.
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Affiliation(s)
- Qiushun Zhang
- School of Clinical Medicine, Jining Medical Uinversity, Jining, China
| | - Yongyi Zhang
- School of Pharmacy, Weifang Medical University, Weifang, China
| | - Wei Meng
- Department of Neurosurgery, Affiliated hospital of Jining medical University, Jining, China
| | - Yifeng Zhao
- Department of Traumatic Orthopedics, Affiliated hospital of Jining medical University, Jining, China
| | - Junchen Zhang
- Department of Neurosurgery, Affiliated hospital of Jining medical University, Jining, China.
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Vaccaro AR, Karamian BA, Levy HA, Canseco JA, Rajasekaran S, Benneker LM, Oner FC, Kandziora F, Schnake KJ, Kepler CK, Schroeder GD. Update on Upper Cervical Injury Classifications: The New AO Upper Cervical Spine Classification System. Clin Spine Surg 2022; 35:249-255. [PMID: 34232156 DOI: 10.1097/bsd.0000000000001215] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 10/20/2022]
Abstract
The upper cervical spine accounts for the largest proportion of cervical range of motion afforded by a complex system of bony morphology and ligamentous stability. Its unique anatomy, however, also makes it particularly vulnerable during both low and high energy trauma. Trauma to this area, referred to as upper cervical spine trauma, can disrupt the stability of the upper cervical spine and result in a wide spectrum of injury. Numerous upper cervical injury classification systems have been proposed, each of which have distinct limitations and drawbacks that have prevented their universal adoption. In this article, we provide an overview of previous classifications, with an emphasis on the development of the new AO Spine Upper Cervical Classification System (AO Spine UCCS).
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Affiliation(s)
- Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Hannah A Levy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | | | - Lorin M Benneker
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
| | | | - Frank Kandziora
- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt
| | - Klaus J Schnake
- Center for Spinal Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Batista AVDES, Aguiar GB, Bennett P, Umigi MR, Veiga JCE. Observational study of patients with occipital condyle fracture at a brazilian referral trauma center. Rev Col Bras Cir 2021; 48:e20213024. [PMID: 34852040 PMCID: PMC10683456 DOI: 10.1590/0100-6991e-20213024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
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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Affiliation(s)
| | | | - Priscilla Bennett
- - Santa Casa de São Paulo School of Medical Science, Neurosurgery - São Paulo - SP - Brasil
| | - Márcia Ramos Umigi
- - Santa Casa de São Paulo School of Medical Science, Neurosurgery - São Paulo - SP - Brasil
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Lassila H, Puolakkainen T, Brinck T, Wilson M, Snäll J. Occipital condyle fracture-A rare but severe injury in cranial fracture patients. J Craniomaxillofac Surg 2021; 49:381-386. [PMID: 33642118 DOI: 10.1016/j.jcms.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/12/2020] [Accepted: 01/31/2021] [Indexed: 11/17/2022] Open
Abstract
We clarified occurrence, severity, and associated injuries of occipital condyle fractures (OCFs) in a cranial fracture population. Retrospective data of cranial fracture patients were analyzed. The outcome variable was presence of OCF in cranial fracture patients. Predictor variables were type of associated injury, Glasgow Coma Scale (GCS) value under 6, and death during hospital care. In addition, occurrence of OCF was assessed according to cranial fracture subtypes. Explanatory variables were age, sex, injury mechanism, involvement of alcohol, and high-energy injury. Treatment and outcome of OCFs were analyzed. Of 637 cranial fracture patients, 19 (3.0%) sustained an OCF, eight of whom had no other cranial fractures. In the multivariate adjusted model, increased risk for OCF was detected in patients with cervical injuries (OR 18.66, 95% CI 5.52, 63.12; p < 0.001) and facial fractures (OR 5.99, 95% CI 1.01, 35.45; p = 0.049). Patients with fractures not extending to the skull base were less likely to have OCF (OR 0.01, 95% CI 0.001, 0.25; p = 0.004), and fractures localized solely to the base of the skull offered a protective effect for OCF (OR 0.19, 95% CI 0.06, 0.58; p = 0.003). All OCFs were treated non-operatively with a cervical collar without complications. OCF patients typically sustain other severe injuries, particularly cervical injuries and facial fractures. Careful screening for associated injuries is therefore crucial when examining a patient with OCF. The classification scheme of Mueller et al. seems to be useful in guiding the treatment of OCFs, at least type 1 and 2 fractures.
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Affiliation(s)
- Henri Lassila
- Department of Surgery, Central Hospital of Päijät-Häme, Keskussairaalankatu 7, 15850, Lahti, Finland.
| | - Tero Puolakkainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4 E, PO Box 220, 00029 HUS, Helsinki, Finland.
| | - Tuomas Brinck
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PO Box 266, 00029 HUS, Helsinki, Finland.
| | - Michael Wilson
- Injury Epidemiology and Prevention (IEP), Turku Brain Injury Center, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521, Turku, Finland; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4 E, PO Box 220, 00029 HUS, Helsinki, Finland.
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van der Burg SJ, Pouw MH, Brink M, Dekker H, Kunst HPM, Hosman AJF. Clinical relevance of occipital condyle fractures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:173-179. [PMID: 33100766 PMCID: PMC7546049 DOI: 10.4103/jcvjs.jcvjs_100_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Abstract
Context: No consensus about classification, treatment, and clinical relevance of occipital condyle fractures (OCFs) exists. Aims: The aim of the study was to determine radiological, clinical, and functional outcome of OCFs and thereby determine its clinical relevance. Settings and Design: This was a retrospective analysis of a prospective follow-up study. Materials and Methods: From May 2005 to May 2008, all OCFs were included from a Level-1 trauma center. Patient files were reviewed for patient and fracture characteristics. Fracture classification was done according to the Anderson criteria. Clinical outcome was assessed by completing two questionnaires, radiological outcome by computed tomography imaging, and functional outcome by measuring active cervical range of motion using a Cybex EDI-320. Statistical Analysis Used: A Fisher's exact Test was used in categorical variables and a one-sample t-test for comparing means of active cervical range of motion in occipital fracture patients with normal values. An independent samples t-test was carried out to compare the means of groups with and without accompanying cervical fractures for each motion. Results: Thirty-nine patients were included (4 type I, 16 type II, and 19 type III). Twenty-seven patients completed follow-up, of whom 26 were treated conservatively. Fracture healing was established in 25 of 28 fractures at a median follow-up of 19 months. Eleven patients had none to minimal pain or disability at follow-up, 12 had mild, and two had moderate pain or disability on questionnaires. No statistically significant difference in active cervical range of motion was identified comparing means stratified for accompanying cervical fractures. Conclusions: Conservatively treated patients with an OCF generally show favorable radiological and clinical outcome.
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Affiliation(s)
- Stijn J van der Burg
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Martin H Pouw
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Monique Brink
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Helena Dekker
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen.,Department of Otorhinolaryngology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Allard J F Hosman
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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