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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.
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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
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Nwachuku E, Njoku-Austin C, Patel KP, Anthony AW, Mittal A, Hamilton DK, Kanter A, Gerszten PC, Okonkwo D. Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary? Surg Neurol Int 2021; 12:524. [PMID: 34754574 PMCID: PMC8571366 DOI: 10.25259/sni_748_2021] [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: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution. Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma. Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment. Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.
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Affiliation(s)
- Enyinna Nwachuku
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Confidence Njoku-Austin
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Kevin P Patel
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Austin W Anthony
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Aditya Mittal
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - David Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Adam Kanter
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Peter C Gerszten
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - David Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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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.
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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
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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.
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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
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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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Alves OL, Pereira L, Kim SH, Grin A, Shimokawa N, Konovalov N, Zileli M. Upper Cervical Spine Trauma: WFNS Spine Committee Recommendations. Neurospine 2020; 17:723-736. [PMID: 33401853 PMCID: PMC7788417 DOI: 10.14245/ns.2040226.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/10/2020] [Indexed: 01/12/2023] Open
Abstract
Craniovertebral junction (CVJ) trauma is a challenging clinical condition. Being a highly mobile functional unit at the junction of the skull and the vertebral column, traumatic events in this area may produce devastating neurological complications and death. Additionally, many of the CVJ traumatic injuries can be left undiagnosed or even raise difficult treatment dilemmas. We present a literature review in the format of recommendations on the diagnosis and management of different scenarios for upper cervical trauma and produce recommendations, which can be applicable to various areas of the globe.
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Affiliation(s)
- Oscar L Alves
- Department of Neurosurgery, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal.,Department of Neurosurgery, Hospital Lusiadas Porto, Porto, Portugal
| | - Leopoldina Pereira
- Department of Neurosurgery, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Andrey Grin
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russian Federation.,A.I. Evdokimov Moscow Medical University, Moscow, Russian Federation
| | | | - Nikolay Konovalov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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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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