1
|
Ledeganck L, Kromhout K, Chiers K, Van der Vekens E, Van Ham L, Bhatti SFM, Cornelis I. CT diagnosis of occipital condyle fracture in a dog presented for severe cervical hyperesthesia. Vet Radiol Ultrasound 2023; 64:E10-E13. [PMID: 36377038 DOI: 10.1111/vru.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/15/2022] [Accepted: 09/17/2022] [Indexed: 11/17/2022] Open
Abstract
A 9-month-old male entire Doberman Pinscher presented with acute onset of severe cervical hyperesthesia after a fall. Neurological examination revealed a normal gait with low head carriage and severe cervical hyperesthesia. A CT scan of the cervical vertebral column revealed the presence of a comminuted fracture at the dorsomedial aspect of the right occipital condyle and sclerosis of the underlying bone. Medical management was initiated consisting of an external bandage, strict rest, and pain medication. Due to the lack of clinical improvement, the dog was euthanized 2 months after diagnosis. Histopathology of the lesion was compatible with a healing fracture.
Collapse
Affiliation(s)
- Liesbet Ledeganck
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Kaatje Kromhout
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Koen Chiers
- Department of Pathology, Bacteriology and Poultry disease, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Elke Van der Vekens
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie F M Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ine Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
2
|
Kalnev M, Uchikov P, Kehayov I. Clinical Behavior of General Practitioners for Patients who Underwent an Operative or Conservative Treatment for a Craniocervical Fracture. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Craniocervical fractures are socially important pathology. They represent one-third of the fractures in the cervical region. It is typical that elderly patients suffer from low-energy traumas such as falls, while younger patients suffer from high-energy traumas such as motor vehicle accidents, sport falls and etc. Craniocervical fractures are associated with an increased risk of craniocervical instability or neurological deficit. Primary therapeutic options depend on the type of fracture. Predictors of nonunions are the displacement of fractures, patients’ age, and comorbidities. The observership of the general practitioner in the postoperative period or the period of cervical immobilization could recognize possible malpositioning of the instrumentation, nonunion of the fracture, malsanation of the wound, and possible complications in case of the external immobilization. There is a lack of information on that topic. The goal of the paper is to summarise the most common fractures of the craniocervical region, their etiology, and treatment options and to present the results of our study of patients who underwent operative treatment for craniocervical fracture(s). Mastering the details, the treatment options, and the possible complication of the fractures in the craniocervical region, general practitioners could play an important role in the treatment of patients.
Collapse
|
3
|
Tomaszewski R, Kler J, Pethe K, Zachurzok A. Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures. J Orthop Surg Res 2021; 16:449. [PMID: 34256792 PMCID: PMC8276397 DOI: 10.1186/s13018-021-02463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
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.
Collapse
Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland. .,Faculty of Science and Technology, Institute of Biomedical Engineering, University of Silesia, Katowice, Poland.
| | - Jacek Kler
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland
| | - Karol Pethe
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre in Katowice, 40-752 Katowice ul. Medyków, 16, Katowice, Poland
| | - Agnieszka Zachurzok
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
4
|
Tomaszewski R, Gap A, Lucyga M, Rutz E, Mayr JM. Treatment of Unstable Occipital Condylar Fractures in Children-A STROBE-Compliant Investigation. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:530. [PMID: 34070410 PMCID: PMC8228604 DOI: 10.3390/medicina57060530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.
Collapse
Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, Medyków 16, 40-752 Katowice, Poland
| | - Artur Gap
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
| | - Magdalena Lucyga
- Department of Pediatric Traumatology and Orthopedics, Upper Silesian Children’s Health Centre, Medyków 16, 40-752 Katowice, Poland; (R.T.); (A.G.); (M.L.)
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Melbourne, VIC 3052, Australia;
| | - Johannes M. Mayr
- Department of Pediatric Surgery, University Children’s Hospital Basel, University of Basel, 4031 Basel, Switzerland
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Occipital Condyle Fracture: A Case Report of a Typically Stable Fracture That Required Surgical Treatment. Case Rep Orthop 2018; 2018:2809546. [PMID: 30581641 PMCID: PMC6276388 DOI: 10.1155/2018/2809546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/01/2018] [Accepted: 11/04/2018] [Indexed: 11/20/2022] Open
Abstract
An occipital condyle fracture (OCF) is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. For nondisplaced OCFs, conservative treatment is generally recommended, and there is no previous report of a nondisplaced OCF requiring surgery. We report a patient who had a nondisplaced OCF with craniocervical misalignment (a condyle-C1 interval > 2.0 mm) and C1-C2 translation treated with a halo vest and occipitocervical fusion surgery. An 87-year-old Asian woman fell from a 4-meter height and hit her head. She was transferred to our emergency room. Computed tomography revealed a nondisplaced impaction OCF with a 2.5 mm occipital condyle-C1 interval and a 5 mm C1-C2 translation. The fracture pattern was considered stable. However, since craniocervical misalignment and C1-C2 translation were present, the patient was placed in a halo device, and we reduced the occipitoatlantoaxial joint, adjusting the halo ring position preoperatively. Confirming reduction of the atlantooccipital facet joint and the atlantoaxial joint by computed tomography, we performed an occipitocervical fusion. This is the first report of a nondisplaced OCF with craniocervical misalignment and C1-C2 translation that required surgical treatment. Clinicians should be aware of craniocervical misalignment and atlantoaxial instability even in Tuli type 1 OCFs.
Collapse
|
7
|
Burks JD, Conner AK, Briggs RG, Bonney PA, Smitherman AD, Baker CM, Glenn CA, Ghafil CA, Pryor DP, O'Connor KP, Bohnstedt BN. Blunt vertebral artery injury in occipital condyle fractures. J Neurosurg Spine 2018; 29:500-505. [PMID: 30074441 DOI: 10.3171/2018.3.spine161177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/14/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVEA shifting emphasis on efficient utilization of hospital resources has been seen in recent years. However, reduced screening for blunt vertebral artery injury (BVAI) may result in missed diagnoses if risk factors are not fully understood. The authors examined the records of blunt trauma patients with fractures near the craniocervical junction who underwent CTA at a single institution to better understand the risk of BVAI imposed by occipital condyle fractures (OCFs).METHODSThe authors began with a query of their prospectively collected trauma registry to identify patients who had been screened for BVAI using ICD-9-CM diagnostic codes. Grade and segment were recorded in instances of BVAI. Locations of fractures were classified into 3 groups: 1) OCFs, 2) C1 (atlas) fractures, and 3) fractures of the C2-6 vertebrae. Univariate and multivariate analyses were performed to identify any fracture types associated with BVAI.RESULTSDuring a 6-year period, 719 patients underwent head and neck CTA following blunt trauma. Of these patients, 147 (20%) had OCF. BVAI occurred in 2 of 43 patients with type I OCF, 1 of 42 with type II OCF, and in 9 of 62 with type III OCF (p = 0.12). Type III OCF was an independent risk factor for BVAI in multivariate modeling (OR 2.29 [95% CI 1.04-5.04]), as were fractures of C1-6 (OR 5.51 [95% CI 2.57-11.83]). Injury to the V4 segment was associated with type III OCF (p < 0.01).CONCLUSIONSIn this study, the authors found an association between type III OCF and BVAI. While further study may be necessary to elucidate the mechanism of injury in these cases, this association suggests that thorough cerebrovascular evaluation is warranted in patients with type III OCF.
Collapse
|
8
|
Musbahi O, Khan AHA, Anwar MO, Chaudery H, Ali AM, Montgomery AS. Immobilisation in occipital condyle fractures: A systematic review. Clin Neurol Neurosurg 2018; 173:130-139. [PMID: 30125835 DOI: 10.1016/j.clineuro.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objectives of this review are to determine the level of evidence for the management of OCF, compare outcomes of different immobilisation, and to review the prognosis. PATIENTS AND METHODS A literature search was conducted using 3 databases (MEDLINE, PubMed and EMBASE). All papers between 1940 and July 2017 were screened using PRISMA guidelines. Inclusion criteria were patients with a confirmed diagnosis of occipital condyle fracture(s) on CT managed with any form of immobilisation with no age restriction. Primary outcome was clinical improvement in symptoms or Neck Disability Index. MINORS and OCEBM level was assigned to each study. RESULTS 25 studies met the inclusion criteria. Most studies used a single form of C-spine immobilisation support (58%) with a semi rigid collar and halo device being the most common. From these studies, the average length of time for immobilisation was 11.7 weeks, 9 weeks and 8.3 weeks for halo, semi-rigid and rigid cervical collars respectively. Neuro deficit was found in 20.3% of patients. OCEBM level of evidence and MINORS score was low. CONCLUSION Management of OCF is associated with low level of evidence. Further studies are needed to determine optimal management of these under-diagnosed fractures.
Collapse
Affiliation(s)
- Omar Musbahi
- Oxford University Clinical Academic Graduate School, Oxford, UK.
| | | | | | - Hannan Chaudery
- Spinal Department, The Royal London Hospital, Whitechapel, London, UK
| | - Adam M Ali
- Department of Trauma and Orthopaedics, Imperial College NHS Trust, London, UK
| | | |
Collapse
|
9
|
Occipital Condyle Fractures and Concomitant Cervical Spine Fractures: Implications for Management. World Neurosurg 2018; 115:e238-e243. [DOI: 10.1016/j.wneu.2018.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/22/2022]
|
10
|
The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging 2016; 8:29-47. [PMID: 27815845 PMCID: PMC5265194 DOI: 10.1007/s13244-016-0530-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/09/2016] [Accepted: 10/13/2016] [Indexed: 12/15/2022] Open
Abstract
Imaging of the blunt traumatic injuries to the craniocervical junction can be challenging but central to improving morbidity and mortality related to such injury. The radiologist has a significant part to play in the appropriate management of patients who have suffered injury to this vital junction between the cranium and the spine. Knowledge of the embryology and normal anatomy as well as normal variant appearances avoids inappropriate investigations in these trauma patients. Osseous injury can be subtle while representing important radiological red flags for significant underlying ligamentous injury. An understanding of bony and ligamentous injury patterns can also give some idea of the biomechanics and degree of force required to inflict such trauma. This will assist greatly in predicting risk for other critical injuries related to vital neighbouring structures such as vasculature, brain stem, cranial nerves and spinal cord. The embryology and anatomy of the craniocervical junction will be outlined in this review and the relevant osseous and ligamentous injuries which can arise as a result of blunt trauma to this site described together. Appropriate secondary radiological imaging considerations related to potential complications of such trauma will also be discussed. TEACHING POINTS • The craniocervical junction is a distinct osseo-ligamentous entity with specific functional demands. • Understanding the embryology of the craniocervical junction may prevent erroneous radiological interpretation. • In blunt trauma, the anatomical biomechanical demands of the ligaments warrant consideration. • Dedicated MRI sequences can provide accurate evaluation of ligamentous integrity and injury. • Injury of the craniocervical junction carries risk of blunt traumatic cerebrovascular injury.
Collapse
|
11
|
Chugh S, Kamian K, Depreitere B, Schwartz ML. Occipital Condyle Fracture with Associated Hypoglossal Nerve Injury. Can J Neurol Sci 2014; 33:322-4. [PMID: 17001823 DOI: 10.1017/s0317167100005229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Occipital condyle fracture (OCF) is a rare injury that was first described by Bell in 1817. In fact, there have been only 96 more reported cases of occipital condyle fractures from 1817 to 1994 of which only 58 survived. Occipital condyle fractures can sometimes go unnoticed or under-diagnosed as they are not always evident on plain radiographs of the cervical spine. Also, in rare cases OCFs can cause damage to the hypoglossal nerve which passes through the hypoglossal canal which is near the occipital condyle. The presence of specific symptoms and clinical signs should lead to the correct diagnosis. This paper describes a patient who was diagnosed with OCFs, but not hypoglossal nerve damage until 20 days following admission to hospital. We point out many factors that contributed to this delayed diagnosis, which ultimately caused severe discomfort to the patient.
Collapse
|
12
|
Krüger A, Oberkircher L, Frangen T, Ruchholtz S, Kühne C, Junge A. Fractures of the occipital condyle clinical spectrum and course in eight patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2014; 4:49-55. [PMID: 24744561 PMCID: PMC3980555 DOI: 10.4103/0974-8237.128525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs. Materials and Methods: All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years). Results: Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only. Discussion: OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar.
Collapse
Affiliation(s)
- Antonio Krüger
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Ludwig Oberkircher
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Thomas Frangen
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Steffen Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Christian Kühne
- Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany
| | - Andreas Junge
- Department of Trauma and Hand Surgery, Hospital of the Brothers of Mercy, Trier, Germany
| |
Collapse
|
13
|
Debernardi A, D'Aliberti G, Talamonti G, Villa F, Piparo M, Ligarotti G, Cenzato M. Traumatic injuries to the craniovertebral junction: a review of rare events. Neurosurg Rev 2013; 37:203-16; discussion 216. [PMID: 23928657 DOI: 10.1007/s10143-013-0492-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/25/2013] [Accepted: 03/10/2013] [Indexed: 01/08/2023]
Abstract
The craniovertebral junction is a specific region of the spine with unique anatomical and biomechanical properties that yields a wide variety of injury patterns. Junctional traumatic fractures and/or dislocations are widely reported in clinical practice, but we could identify only a subgroup of upper cervical spine traumatic injuries with very few cases reported in the literature, and for this reason may be considered rare. In some of these cases, the absence of spinal biomechanical instability, in association with moderate clinical symptoms (neck stiffness and pain) and the difficulty in fracture identification through standard cervical radiographs, leads to a high percentage of missed injuries. In other cases, traumatic events have been commonly described only in autopsy series due to the high degree of spinal biomechanical instability. Herein, we have summarized all the relevant literature concerning this issue and also included our cases, with the aim of emphasizing prompt diagnosis and correct management. We provide a guide for correctly identifying "rare" craniovertebral junction traumatic injuries.
Collapse
Affiliation(s)
- Alberto Debernardi
- Department of Neurosurgery, Niguarda Cà Granda Hospital, P.zza Ospedale Maggiore, 3, 20162, Milan, Italy,
| | | | | | | | | | | | | |
Collapse
|
14
|
Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC, Hadley MN. Occipital Condyle Fractures. Neurosurgery 2013; 72 Suppl 2:106-13. [DOI: 10.1227/neu.0b013e3182775527] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Sanjay S. Dhall
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Daniel E. Gelb
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - R. John Hurlbert
- Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Timothy C. Ryken
- Iowa Spine & Brain Institute, University of Iowa, Waterloo/Iowa City, Iowa
| | - Beverly C. Walters
- Department of Neurosciences, Inova Health System, Falls Church, Virginia
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark N. Hadley
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
15
|
|
16
|
Noronha HG, Letaif OB, Rocha IDD, Iutaka AS, Cristante AF, Oliveira RPD, Barros Filho TEPD. Fraturas do côndilo occipital: atualização da experiência em nosso serviço e revisão da literatura. COLUNA/COLUMNA 2013. [DOI: 10.1590/s1808-18512013000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Apresentamos 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.
Collapse
|
17
|
Chittiboina P, Banerjee AD, Nanda A. Do concomitant cranium and axis injuries predict worse outcome? A trauma database quantitative analysis. Skull Base 2012; 21:249-54. [PMID: 22470268 DOI: 10.1055/s-0031-1280679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We performed a trauma database analysis to identify the effect of concomitant cranial injuries on outcome in patients with fractures of the axis. We identified patients with axis fractures over a 14-year period. A binary outcome measure was used. Univariate and multiple logistic regression analysis were performed. There were 259 cases with axis fractures. Closed head injury was noted in 57% and skull base trauma in 14%. Death occurred in 17 cases (6%). Seventy-two percent had good outcome. Presence of abnormal computed tomography head findings, skull base fractures, and visceral injury was significantly associated with poor outcome. Skull base injury in association with fractures of the axis is a significant independent predictor of worse outcomes, irrespective of the severity of the head injury. We propose that presence of concomitant cranial and upper vertebral injuries require careful evaluation in view of the associated poor prognosis.
Collapse
Affiliation(s)
- Prashant Chittiboina
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | | | | |
Collapse
|
18
|
Taghva A, Hoh DJ, Lauryssen CL. Advances in the management of spinal cord and spinal column injuries. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:105-30. [PMID: 23098709 DOI: 10.1016/b978-0-444-52137-8.00007-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Spinal cord injury (SCI) is a significant public problem, with recent data suggesting that over 1 million people in the U.S.A. alone are affected by paralysis resulting from SCI. Recent advances in prehospital care have improved survival as well as reduced incidence and severity of SCI following spine trauma. Furthermore, increased understanding of the secondary mechanisms of injury following SCI has provided improvements in critical care and acute management in patients suffering from SCI, thus limiting morbidity following injury. In addition, improved technology and biomechanical understanding of the mechanisms of spine trauma have allowed further advances in available techniques for spinal decompression and stabilization. In this chapter we review the most recent data and salient literature regarding SCI and address current controversies, including the use of pharmacological adjuncts in the setting of acute SCI. We will also attempt to provide a reader with basic understanding of the classifications of SCI and spinal column injury. Finally, we review advances in spinal column stabilization including improvements in instrumented fusion and minimally invasive surgery.
Collapse
Affiliation(s)
- Alexander Taghva
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA.
| | | | | |
Collapse
|
19
|
Abstract
OBJECTIVE The anatomy, clinical presentation, radiologic evaluation, treatment, and outcome of occipital condyle fractures are reviewed. METHODS We review and discuss the literature on occipital condyle fractures. RESULTS Occipital condyle fractures are best diagnosed with computed tomography. The neurologic presentation is variable. The majority of these injuries may be treated nonoperatively, but an occipitocervical fusion is necessary to restore stability across the craniovertebral junction. CONCLUSION Occipital condyle fractures are a rare but serious injury that requires prompt diagnosis and treatment.
Collapse
Affiliation(s)
- Youssef R Karam
- Department of Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | |
Collapse
|
20
|
Maserati MB, Stephens B, Zohny Z, Lee JY, Kanter AS, Spiro RM, Okonkwo DO. Occipital condyle fractures: clinical decision rule and surgical management. J Neurosurg Spine 2009; 11:388-95. [PMID: 19929333 DOI: 10.3171/2009.5.spine08866] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
Collapse
Affiliation(s)
- Matthew B Maserati
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh, Pennsylvania 15213, USA
| | | | | | | | | | | | | |
Collapse
|
21
|
Huang DW, Tai SH, Hung YC, Fang VK, Lee MY, Lee EJ. A rare occipital condyle fracture in a patient with a minor head injury. Kaohsiung J Med Sci 2009; 25:342-6. [PMID: 19561000 DOI: 10.1016/s1607-551x(09)70526-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Occipital condyle fracture (OCF) is an uncommon but potentially fatal disease entity. It is most commonly identified in patients suffering from severe craniocerebral trauma. The advent of computed tomography has made early detection possible. Traditional treatment using a hard neck collar is sufficient to produce solid fusion in most OCF patients. Delayed diagnosis, however, may result in neurologic deterioration due to potential displacement of fractured condylar fragments. Here we report a case of isolated, stable OCF in a patient with a minor head injury. A high level of clinical awareness of this rare disease entity is imperative for the management of traumatized patients, especially for those who have minor head injuries but persistent neck pain.
Collapse
Affiliation(s)
- Da-Wei Huang
- Division of Neurosurgery, Department of Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
| | | | | | | | | | | |
Collapse
|
22
|
Paiva WS, Rusafa-Neto E, Amorim RLO, Figueiredo EG, de Andrade AF, Teixeira MJ. Occipital condyle fracture in a patient with head trauma. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:119-20. [PMID: 19330228 DOI: 10.1590/s0004-282x2009000100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Wellingson Silva Paiva
- Division of Neurosurgery, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | | |
Collapse
|
23
|
Malham GM, Ackland HM, Jones R, Williamson OD, Varma DK. Occipital condyle fractures: incidence and clinical follow-up at a level 1 trauma centre. Emerg Radiol 2009; 16:291-7. [PMID: 19189141 DOI: 10.1007/s10140-008-0789-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 12/15/2008] [Indexed: 12/01/2022]
Abstract
The purpose of the study was to investigate the incidence, management, and outcomes of occipital condyle fractures at a level 1 trauma center. Blunt trauma patients with occipital condyle fracture admitted to a level 1 trauma center over a 3-year period were identified. Prospective clinical and functional follow-up was undertaken, including further radiographic imaging. The incidence of occipital condyle fracture in patients presenting to our level 1 trauma center was 1.7/1,000 per year. Twenty-four patients were followed up at a mean of 27 months post-injury. There was one case of isolated occipital condyle fracture; all other patients had sustained additional orthopedic, cervical spine, and/or head injury. Seven (29%) patients sustained unilateral Type III avulsion fractures, none of which were isolated injuries. Traumatic brain injury was detected in 46% of study patients, and 42% had cervical spine injury. External halothoracic immobilization was used in 33% of cases. Fracture union with anatomical alignment occurred in 21 patients (88%). No patient had cranial nerve deficit at admission or follow-up. Three patients (12.5%) had moderate to severe neck pain/disability at follow-up, all of whom had sustained multiple injuries. Occipital condyle fractures most frequently occur in conjunction with additional injuries, particularly head and cervical spine injuries. Most cases can be managed successfully nonoperatively. Functional outcome is generally determined by pain and disability related to other injuries, rather than occipital fracture configuration.
Collapse
Affiliation(s)
- Gregory M Malham
- Department of Neurosurgery, The Alfred Hospital, Commercial Road, Melbourne, 3004, Australia.
| | | | | | | | | |
Collapse
|
24
|
Tewari MK, Ratnam KL, Shiv VK. Unilateral occipital condylar fracture presenting as neck pain and restriction of neck movements- Report of a case and review of literature. INDIAN JOURNAL OF NEUROTRAUMA 2008. [DOI: 10.1016/s0973-0508(08)80015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractOccipital condylar fractures (OCFs) once rare injuries are not so at present. A young male, victim of motor vehicle accident, presented with severe high cervical pain and restriction of neck movements without any focal neurological deficit, with normal cervical spine x-rays and computerized tomography (CT) scans brain. CT scan and magnetic resonance (MR) imaging of the craniovertebral junction (CVJ) area revealed a retro-pulsed segment in the cervical spinal canal with no cord compression or ligament injury. Patient improved with immobilization of neck. Patients with severe high cervical pain and restricted head movements OCF should be suspected and patient should be evaluated further. Majority of stable OCF improve with immobilization only.
Collapse
|
25
|
Dashti R, Ulu MO, Albayram S, Aydin S, Ulusoy L, Hanci M. Concomitant fracture of bilateral occipital condyle and inferior clivus: what is the mechanism of injury? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16 Suppl 3:261-4. [PMID: 17180399 PMCID: PMC2148078 DOI: 10.1007/s00586-006-0270-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 10/14/2006] [Accepted: 11/06/2006] [Indexed: 10/23/2022]
Abstract
With the routine use of multi-slice high resolution computed tomography, increasing number of occipital condyle fractures have been reported in the last decade. The authors report a very rare case of bilateral occipital condyle fracture complicated by the fracture of the inferior clivus and discuss the possible mechanisms of injury.
Collapse
MESH Headings
- Accidents, Traffic
- Adult
- Atlanto-Axial Joint/diagnostic imaging
- Atlanto-Axial Joint/injuries
- Atlanto-Axial Joint/pathology
- Atlanto-Occipital Joint/diagnostic imaging
- Atlanto-Occipital Joint/injuries
- Atlanto-Occipital Joint/pathology
- Cranial Fossa, Posterior/diagnostic imaging
- Cranial Fossa, Posterior/injuries
- Cranial Fossa, Posterior/pathology
- External Fixators
- Functional Laterality/physiology
- Head Injuries, Closed/diagnostic imaging
- Head Injuries, Closed/pathology
- Head Injuries, Closed/physiopathology
- Humans
- Ligaments/diagnostic imaging
- Ligaments/injuries
- Ligaments/pathology
- Magnetic Resonance Imaging
- Male
- Occipital Bone/diagnostic imaging
- Occipital Bone/injuries
- Occipital Bone/pathology
- Pneumothorax/complications
- Respiratory Distress Syndrome/complications
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/pathology
- Skull Fracture, Basilar/physiopathology
- Subarachnoid Hemorrhage/complications
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Reza Dashti
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, P.O. Box: 9, Cerrahpasa, Aksaray, 34303, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteo-ligamentous instability with spinal cord injury. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries; elucidate associated pathology; classify injuries; and predict instability, treatment and outcomes. The unique anatomy of each region of the cervical spine demands a review of each segment individually. This article examines both upper cervical spine injuries, as well as subaxial spine trauma. The purpose of this article is to provide a review of the broad topic of cervical spine trauma with reference to the classic literature, as well as to summarize all recently available literature on each topic. IDENTIFICATION OF REFERENCES FOR INCLUSION: A Pubmed and Ovid search was performed for each topic in the review to identify recently published articles relevant to the review. In addition prior reviews and classic references were evaluated individually for inclusion of classic papers, classifications and previously unidentified references.
Collapse
Affiliation(s)
- Joel A Torretti
- University Orthopedics Center 101 Regent Ct State College, PA 16801, USA
| | - Dilip K Sengupta
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon
| |
Collapse
|
27
|
Alcelik I, Manik KS, Sian PS, Khoshneviszadeh SE. Occipital condylar fractures. Review of the literature and case report. ACTA ACUST UNITED AC 2006; 88:665-9. [PMID: 16645117 DOI: 10.1302/0301-620x.88b5.16598] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fractures of the occipital condyle are rare. Their prompt diagnosis is crucial since there may be associated cranial nerve palsies and cervical spinal instability. The fracture is often not visible on a plain radiograph. We report the case of a 21-year-old man who sustained an occipital condylar fracture without any associated cranial nerve palsy or further injuries. We have also reviewed the literature on this type of injury, in order to assess the incidence, the mechanism and the association with head and cervical spinal injuries as well as classification systems, options for treatment and outcome.
Collapse
Affiliation(s)
- I Alcelik
- Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK
| | | | | | | |
Collapse
|
28
|
Chen JY, Soares G, Lambiase R, Murphy T, Biffl W. A previously unrecognized connection between occipital condyle fractures and internal carotid artery injuries (carotid and condyles). Emerg Radiol 2006; 12:192-5. [PMID: 16601998 DOI: 10.1007/s10140-006-0471-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 12/16/2005] [Indexed: 11/29/2022]
Affiliation(s)
- James Y Chen
- Department of Diagnostic Imaging, Rhode Island Hospital, 595 Eddy St., Providence, RI 02903, USA.
| | | | | | | | | |
Collapse
|
29
|
Aulino JM, Tutt LK, Kaye JJ, Smith PW, Morris JA. Occipital condyle fractures: clinical presentation and imaging findings in 76 patients. Emerg Radiol 2005; 11:342-7. [PMID: 16344975 DOI: 10.1007/s10140-005-0425-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2005] [Accepted: 05/18/2005] [Indexed: 10/25/2022]
Abstract
The aim was to assess the frequency and type of occipital condyle fractures in patients with significant trauma, and determine the frequency in which conventional radiographic findings are positive. Secondarily, we subjectively evaluate the application of existing classification systems. Fracture of the occipital condyle is an uncommon lesion that may be associated with craniocervical instability. Relying on conventional radiographs to detect these injuries may be inappropriate. An institutional trauma database of patients was searched for patients with occipital condyle fractures. The types of fractures were classified retrospectively based on re-review of imaging studies, using existing classification systems. Frequency of types was calculated, and the ease of use of the fracture classifications was evaluated subjectively. Conventional radiographs were reviewed for the presence of subjective soft tissue swelling and the visibility of the fracture(s). Seventy-six patients had CT images available for re-review. None of the occipital condyle fractures could be identified in the 60 patients who had radiographs available for re-review. Because of the presence of life support tubing and pharyngeal fluid limiting evaluation of prevertebral soft tissue swelling, the presence of widened prevertebral soft tissues was only helpful in 7 of the 60 patients. The multiplanar reformatted CT images were useful to determine alignment at C0-C1 and C1-C2. Occipital condyle fractures were not visualized on conventional radiographs. Secondary findings of soft tissue swelling were often absent or unreliable. CT scanning with multiplanar reconstruction imaging plays an indispensable role in evaluating for fractures of the cervical spine, and for determining alignment at C0-C1-C2. The most recently developed classification system of Tuli et al. (Neurosurgery 41: 368-376, 1997) is useful, but suffers from the lack of a defined distinction between undisplaced (Type I, stable) and displaced (Type 2A, unstable) fracture fragments.
Collapse
Affiliation(s)
- Joseph M Aulino
- Department of Radiology and Radiological Sciences, Neuroradiology and Musculoskeletal Imaging Sections, Vanderbilt University Medical Center, MCN, 21st Avenue South, Nashville, TN, 37232-2675, USA.
| | | | | | | | | |
Collapse
|
30
|
Caroli E, Rocchi G, Orlando ER, Delfini R. Occipital condyle fractures: report of five cases and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 14:487-92. [PMID: 15754215 PMCID: PMC3454667 DOI: 10.1007/s00586-004-0832-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Accepted: 09/26/2004] [Indexed: 11/29/2022]
Abstract
Occipital condyle fractures (OCFs) are uncommon and potentially fatal lesions. After the advent of CT, prompt diagnosis can be readily made and consequently better prognosis of these patients is expected. Early recognition of some types of OCF is imperative to avoid fatal results. We analyzed 121 cases of OCF (116 from the literature and five of our own). Rarely patients with a deficit of the lower cranial nerves make a complete recovery. However, quoad vitam prognosis of patients with "pure OCFs" remains good. Immobilization provides good recovery of most OCFs, but delay of treatment can lead to serious morbidity. We want to emphasize that not only an OCF with instability of O-C1-C2 can be a fatal injury unless prompt surgical intervention, but a displacement and migration of the fractured condylar fragment can also result in a fatal outcome. A high level of suspicion is fundamental for the early diagnosis of these fractures, so that when a posterior basal cranial or occipital squama fracture occurs, a CT study of the occipital condyles becomes imperative.
Collapse
Affiliation(s)
- Emanuela Caroli
- Department of Neurological Sciences, Neurosurgery, S. Andrea Hospital, University of Rome "La Sapienza", Via Meropia, 85-00147 Rome, Italy.
| | | | | | | |
Collapse
|
31
|
Abstract
Ethical concerns have hindered any randomised control blinded studies on the imaging required to assess the cervical spine in an unconscious trauma patient. The issue has been contentious for many years and has resulted in burgeoning but inconclusive guidance. MRI and multislice CT technology have made rapid advances, but the literature is slower to catch up. Never the less there appears to be an emerging consensus for the multiply injured patient. The rapid primary clinical survey should be followed by lateral cervical spine, chest and pelvic radiographs. If a patient is unconscious then CT of the brain and at least down to C3 (and in the USA down to D1) has now become routine. The cranio-cervical scans should be a maximum of 2 mm thickness, and probably less, as undisplaced type II peg fractures, can be invisible even on 1 mm slices with reconstructions. If the lateral cervical radiograph and the CT scan are negative, then MRI is the investigation of choice to exclude instability. Patients with focal neurological signs, evidence of cord or disc injury, and patients whose surgery require pre-operative cord assessment should be imaged by MRI. It is also the investigation of choice for evaluating the complications and late sequela of trauma. If the patient is to have an MRI scan, the MR unit must be able to at least do a sagittal STIR sequence of the entire vertebral column to exclude non-contiguous injuries, which, since the advent of MRI, are now known to be relatively common. Any areas of oedema or collapse then require detailed CT evaluation. It is important that cases are handled by a suitably skilled multidisciplinary team, and avoid repeat imaging due to technical inadequacies. The aim of this review is to re-examine the role of cervical spine imaging in the context of new guidelines and technical advances in imaging techniques.
Collapse
Affiliation(s)
- Paula J Richards
- X-ray Department, University Hospital of North Staffordshire NHS Trust (UHNS), Princes Road, Hartshill, Stoke on Trent ST4 7LN, UK.
| |
Collapse
|
32
|
Payer M, Delavelle J. Bilateral occipital condylar fracture. Case report about successful treatment with SOMI brace. J Clin Neurosci 2004; 11:211-4. [PMID: 14732389 DOI: 10.1016/j.jocn.2003.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment guidelines for occipital condyle fractures (OCFs) are not established. Options for unilateral OCF have been discussed in the literature, but not for bilateral cases. We describe a bilateral OCF type II (according to the Anderson/Montesano classification) in a 30-year-old patient, where immobilisation in a SOMI brace (sternal occipital mandibular immobilisation) was successfully used.
Collapse
Affiliation(s)
- M Payer
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland.
| | | |
Collapse
|
33
|
Neeman Z, Bloom AI. Occipital Condyle Fractures in the Pediatric Population. Radiographics 2003; 23:1699-701; author reply 1699-701. [PMID: 14615574 DOI: 10.1148/rg.236035138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
34
|
Kaushik V, Kelly G, Richards SD, Saeed SR. Isolated unilateral hypoglossal nerve palsy after minor head trauma. Clin Neurol Neurosurg 2002; 105:42-7. [PMID: 12445924 DOI: 10.1016/s0303-8467(02)00101-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Isolated unilateral hypoglossal nerve palsy after fracture of the occipital condyle is rare. It usually occurs after major trauma, such as high-speed deceleration injuries following road traffic accidents. We describe a case that resulted from minor trauma. An underlying skull base malformation may have been a predisposing factor.
Collapse
Affiliation(s)
- Vivek Kaushik
- University Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M139WL, UK
| | | | | | | |
Collapse
|
35
|
Hanson JA, Deliganis AV, Baxter AB, Cohen WA, Linnau KF, Wilson AJ, Mann FA. Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients. AJR Am J Roentgenol 2002; 178:1261-8. [PMID: 11959743 DOI: 10.2214/ajr.178.5.1781261] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We proposed to characterize the radiologic spectrum of occipital condyle fractures in a large series of patients and to correlate fracture pathology with neurosurgical treatment and patient outcome. MATERIALS AND METHODS We conducted a retrospective review of the findings on conventional radiography, CT, and MR imaging in 95 patients with 107 occipital condyle fractures. We described fracture patterns according to two previously published classification systems. Clinical findings, neurosurgical management, and patient outcome were obtained from the medical records. RESULTS Inferomedial avulsions (Anderson and Montesano type III) were the most common type of occipital condyle fracture, constituting 80 (75%) of 107 overall fractures. Unilateral occipital condyle fractures were found in 73 (77%) of 95 patients, and 58 patients were treated nonoperatively; occipitocervical fusion was required in nine patients for complex C1-C2 injuries, and six patients died. Bilateral occipital condyle fractures or occipitoatlantoaxial joint injuries were seen in 22 (23%) of 95 patients. Occipitocervical fusion or halo traction for the craniocervical junction was required in 12 patients, all of whom had CT evidence of bilateral occipitoatlantoaxial joint disruption and six of whom showed normal craniocervical relationships on conventional radiographs. Six patients with nondisplaced fractures were treated nonoperatively, and four patients died. Thirty (32%) of 95 patients showed continued disability, whereas 55 (57.5%) of 95 patients had good outcomes at 1 month. Associated cervical spine injuries were present in 29 (31%) of 95 patients. CONCLUSION Given their associated traumatic brain and cervical spine injuries, occipital condyle fractures are markers of high-energy traumas. That conventional radiographs alone may miss up to half of the patients with acute craniocervical instability has not been well established. Avulsion fracture type and fracture displacement are associated with both injury mechanism and the need for surgical stabilization. In this series, most unilateral occipital condyle fractures were treated nonoperatively, whereas bilateral occipitoatlantoaxial joint injuries with findings of instability usually required surgical stabilization.
Collapse
Affiliation(s)
- Julian A Hanson
- Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Ave., Box 359728, Seattle, WA 98104, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Bibliography. Neurosurgery 2002. [DOI: 10.1097/00006123-200203001-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
37
|
Abstract
DIAGNOSTIC STANDARDS There is insufficient evidence to support diagnostic standards. GUIDELINES Computed tomographic imaging is recommended for establishing the diagnosis of occipital condyle fractures. Clinical suspicion should be raised by the presence of one or more of the following criteria: blunt trauma patients sustaining high-energy craniocervical injuries, altered consciousness, occipital pain or tenderness, impaired cervical motion, lower cranial nerve paresis, or retropharyngeal soft tissue swelling. OPTIONS Magnetic resonance imaging is recommended to assess the integrity of the craniocervical ligaments. TREATMENT STANDARDS There is insufficient evidence to support treatment standards. GUIDELINES There is insufficient evidence to support treatment guidelines. OPTIONS Treatment with external cervical immobilization is recommended.
Collapse
|
38
|
Aran E, Vilarinho A, Vaz R. [Occipital condyle fracture without neurological deficit: apropos of a case]. Neurocirugia (Astur) 2001; 12:517-20. [PMID: 11787401 DOI: 10.1016/s1130-1473(01)70670-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fracture of the occipital condyles is a rare pathology that can be easily undiagnosed. The bibliographic references on this theme are scarce and the majority are related to patients with palsy of the low cranial nerves and/or a high cervical subluxation with abnormal posture of the neck. The authors describe one case of the occipital condyle fracture without clinical manifestations other than persistent pain, and without alterations of the high cervical region. The patient was submitted to conservative treatment by means of a cervical collar due to the existence of minor symptoms. The clinical criteria that should lead to the study of this pathology are discussed, just as the use of a computerized tomography bone window as the fundamental instrument in its diagnosis and classification.
Collapse
Affiliation(s)
- E Aran
- Serviço de Neurocirurgia, Hospital de São João, Porto, Portugal
| | | | | |
Collapse
|
39
|
Su TM, Lui CC, Cheng MH, Tsai SC. Occipital condyle fracture with hypoglossal nerve palsy: case report. THE JOURNAL OF TRAUMA 2000; 49:1144-6. [PMID: 11130506 DOI: 10.1097/00005373-200012000-00032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- T M Su
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan
| | | | | | | |
Collapse
|
40
|
Miyazaki C, Katsume M, Yamazaki T, Aoki K, Kuroki T, Takasu N. Unusual occipital condyle fracture with multiple nerve palsies and Wallenberg syndrome. Clin Neurol Neurosurg 2000; 102:255-258. [PMID: 11154817 DOI: 10.1016/s0303-8467(00)00109-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 52-year-old male presented with an extremely rare fracture of the occipital condyle involving the jugular foramen with marked medial rostrad displacement of the fragments. He had ipsilateral VII through XII nerves palsies and Wallenberg syndrome. Conservative treatment did not improve the cranial nerve palsies. A high-resolution CT-scan is essential to visualize these fractures.
Collapse
Affiliation(s)
- C Miyazaki
- Department of Neurosurgery, Sakura Hospital, Toho University, School of Medicine, 564-1 Shimoshizu, Sakura-shi, 285-0841, Chiba, Japan
| | | | | | | | | | | |
Collapse
|
41
|
Deliganis AV, Baxter AB, Hanson JA, Fisher DJ, Cohen WA, Wilson AJ, Mann FA. Radiologic spectrum of craniocervical distraction injuries. Radiographics 2000; 20 Spec No:S237-50. [PMID: 11046174 DOI: 10.1148/radiographics.20.suppl_1.g00oc23s237] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Injuries to the atlanto-occipital region, which range from complete atlanto-occipital or atlantoaxial dislocation to nondisplaced occipital condyle avulsion fractures, are usually of critical clinical importance. At initial cross-table lateral radiography, measurement of the basion-dens and basion-posterior axial line intervals and comparison with normal measurements may help detect injury. Computed tomography (CT) with sagittal and coronal reformatted images permits optimal detection and evaluation of fracture and luxation. CT findings that may suggest atlanto-occipital injury include joint incongruity, focal hematomas, vertebral artery injury, capsular swelling, and, rarely, fractures through cranial nerve canals. Magnetic resonance (MR) imaging of the cervical spine with fat-suppressed gradient-echo T2-weighted or short-inversion-time inversion recovery sequences can demonstrate increased signal intensity in the atlantoaxial and atlanto-occipital joints, craniocervical ligaments, prevertebral soft tissues, and spinal cord. Axial gradient-echo MR images may be particularly useful in assessing the integrity of the transverse atlantal ligament. All imaging studies should be conducted with special attention to bone integrity and the possibility of soft-tissue injury. Atlanto-occipital injuries are now recognized as potentially survivable, although commonly with substantial morbidity. Swift diagnosis by the trauma radiologist is crucial for ensuring prompt, effective treatment and preventing delayed neurologic deficits in patients who survive such injuries.
Collapse
Affiliation(s)
- A V Deliganis
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195-7115, USA.
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
The purpose of this review article is to summarize the epidemiology, pertinent anatomy, mechanisms of injury, and classification systems of occipital condylar fractures (OCFs), as well as their clinical presentation and screening, the importance of computed tomography (CT) for detection, and current treatment options. The authors emphasize the rate of occurrence of OCFs, which may be detected in as many as 16% of patients with craniocervical injury. Clinical presentation is not specific, and OCF is not readily diagnosed at physical examination. Failure to diagnose may result in substantial morbidity, and thus accurate diagnosis is mandatory for both therapeutic and medicolegal implications. The diagnosis is most likely to be made with CT. Thin-section CT technique is the method of choice to evaluate the traumatized craniocervical junction. OCFs should be suspected in all patients sustaining high-energy blunt trauma to the head and/or upper cervical spine, resulting from axial loading, lateral bending and/or rotation, and/or direct blow. Besides a CT study assessing potential intracranial injuries, these patients require CT of the craniocervical junction. Radiologists should be aware of the types of OCFs and associated injuries.
Collapse
Affiliation(s)
- A Leone
- Departments of Radiology, Università Cattolica del Sacro Cuore, Policlinico "Agostino Gemelli," Largo Agostino Gemelli, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
43
|
Ide C, Nisolle JF, Misson N, Trigaux JP, Gustin T, De Coene B, Gilliard C. Unusual occipitoatlantal fracture dissociation with no neurological impairment. Case report. J Neurosurg 1998; 88:773-6. [PMID: 9525728 DOI: 10.3171/jns.1998.88.4.0773] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors describe an unusual case of a complex traumatic fracture-dissociation injury of the craniovertebral junction, which the patient survived with no neurological damage. This case featured the rare combination of an avulsion of both the right occipital condyle and clivus and a fracture of the left lateral mass of the atlas. Because of the craniocervical ligament injury and the slight anterior occipitoatlantal dislocation, the lesion was considered to be unstable and was treated successfully with a cervical collar. The authors emphasize that thin-slice computerized tomography scanning with multiplanar reconstructions is essential to visualize these fractures, whereas magnetic resonance imaging is useful to assess soft tissues.
Collapse
Affiliation(s)
- C Ide
- Department of Radiology, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium
| | | | | | | | | | | | | |
Collapse
|