scholarly journals Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

2021 ◽  
Vol 12 ◽  
pp. 524
Author(s):  
Enyinna Nwachuku ◽  
Confidence Njoku-Austin ◽  
Kevin P. Patel ◽  
Austin W. Anthony ◽  
Aditya Mittal ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Collar ◽  
Occipital Condyle ◽  
Type I ◽  
Occipitocervical Fusion ◽  
Orthopedic Injury ◽  
Trauma Population ◽  
Cervical Orthosis ◽  
Cervical Spine Fractures ◽  
Occipital Condyle Fractures

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.

Occipital Condyle Fractures and Concomitant Cervical Spine Fractures: Implications for Management

2018 ◽  
Vol 115 ◽  
pp. e238-e243 ◽  
Author(s):  
James L. West ◽  
Atilio E. Palma ◽  
Lukas Vilella ◽  
Kyle M. Fargen ◽  
Charles L. Branch ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Occipital Condyle ◽  
Spine Fractures ◽  
Cervical Spine Fractures ◽  
Occipital Condyle Fractures

Occipital condyle fractures: clinical decision rule and surgical management

2009 ◽  
Vol 11 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Matthew B. Maserati ◽  
Bradley Stephens ◽  
Zohny Zohny ◽  
Joon Y. Lee ◽  
Adam S. Kanter ◽  
...  
Keyword(s):  
Clinical Decision ◽  
Cervical Collar ◽  
Classification Systems ◽  
Ct Scans ◽  
Occipital Condyle ◽  
Neural Element ◽  
Spine Trauma ◽  
Occipitocervical Fusion ◽  
Occipital Condyle Fractures

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.

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

2021 ◽  
Vol 48 ◽  
Author(s):  
ANDREW VINÍCIUS DE SOUZA BATISTA ◽  
GUILHERME BRASILEIRO AGUIAR ◽  
PRISCILLA BENNETT ◽  
MÁRCIA RAMOS UMIGI ◽  
JOSÉ CARLOS ESTEVES VEIGA
Keyword(s):  
Observational Study ◽  
Trauma Center ◽  
Traffic Accidents ◽  
Cervical Collar ◽  
Occipital Condyle ◽  
Occipital Condyle Fracture ◽  
Condyle Fracture ◽  
Occipital Condyle Fractures ◽  
Type 3 ◽  
Epidemiological Characteristics

ABSTRACT Objective: to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America. Methods: this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center. Results: a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was the main determinant for negative outcomes. Conclusion: the findings of this study are in accordance with available literature data. The use of external stabilization with a cervical collar is reinforced for the treatment of stable lesions, even when these are bilateral. Assessment of the patients’ follow-up results in the studied sample may contribute with useful information for the treatment of occipital condyle fractures.

Occipital condyle to cervical spine fixation in the pediatric population

2014 ◽  
Vol 13 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Libby Kosnik-Infinger ◽  
Steven S. Glazier ◽  
Bruce M. Frankel
Keyword(s):  
Cervical Spine ◽  
Posterior Fossa ◽  
Pediatric Population ◽  
Occipital Bone ◽  
Occipital Condyle ◽  
Type I ◽  
Posterior Fossa Surgery ◽  
Clinical Scenarios ◽  
Spine Fixation ◽  
Cervical Spine Fixation

Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct. Adult cadaveric and a limited number of case studies have been published using occipital condyle (C-0) fixation. This work was adapted for the pediatric population. Between 2009 and 2012, 4 children underwent occipital condyle to axial or subaxial spine fixation. One patient had previously undergone posterior fossa surgery for tumor resection, and 1 required decompression at the time of operation. Two patients underwent preoperative deformity reduction using traction. One child had a Chiari malformation Type I. Each procedure was performed using polyaxial screw-rod constructs with intraoperative neuronavigation supplemented by a custom navigational drill guide. Smooth-shanked 3.5-mm polyaxial screws, ranging in length from 26 to 32 mm, were placed into the occipital condyles. All patients successfully underwent occipital condyle to cervical spine fixation. In 3 patients the construct extended from C-0 to C-2, and in 1 from C-0 to T-2. Patients with preoperative halo stabilization were placed in a cervical collar postoperatively. There were no new postoperative neurological deficits or vascular injuries. Each patient underwent postoperative CT, demonstrating excellent screw placement and evidence of solid fusion. Occipital condyle fixation is an effective option in pediatric patients requiring occipitocervical fusion for treatment of deformity and/or instability at the CVJ. The use of intraoperative neuronavigation allows for safe placement of screws into C-0, especially when faced with a challenging patient in whom fixation to the occipital bone is not possible or is less than ideal.

Cervical spine injuries

2010 ◽  
pp. 276-286
Author(s):  
George Samandouras
Keyword(s):  
Cervical Spine ◽  
Occipital Condyle ◽  
Spine Fractures ◽  
Cervical Spine Injuries ◽  
Occipital Condyle Fracture ◽  
Subaxial Cervical Spine ◽  
Spine Injuries ◽  
Condyle Fracture ◽  
Cervical Spine Fractures

Chapter 6.6 covers cervical spine injuries, including atlanto-occipital dislocation (AOD), occipital condyle fracture (OCF), fracture of the atlas: C1 (FOTA), fracture of the axis: C2 (FOAX), combination fractures: C1–C2, atlanto-axial instability (AAI), and subaxial cervical spine fractures.

scholarly journals Blunt vertebral artery injury in occipital condyle fractures

2018 ◽  
Vol 29 (5) ◽  
pp. 500-505 ◽  
Author(s):  
Joshua D. Burks ◽  
Andrew K. Conner ◽  
Robert G. Briggs ◽  
Phillip A. Bonney ◽  
Adam D. Smitherman ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Blunt Trauma ◽  
Craniocervical Junction ◽  
Vertebral Artery Injury ◽  
Occipital Condyle ◽  
Trauma Patients ◽  
Type I ◽  
Type Iii ◽  
Artery Injury ◽  
Occipital Condyle Fractures

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.

scholarly journals Semirigid cervical spine collar and risk of missing significant soft tissue injuries

2019 ◽  
Vol 12 (4) ◽  
pp. e228761
Author(s):  
Mohammed Hassan Hussain ◽  
Kenneth Corsar
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Prehospital Care ◽  
Soft Tissue Injuries ◽  
Rear Seat ◽  
Cervical Collar ◽  
Fundamental Aspect ◽  
Tissue Injuries ◽  
Cervical Spine Fractures ◽  
Scalp Injury

We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.

scholarly journals Occipitocervical fusion of traumatic atlanto-occipital dissociation in a patient with autofused cervical facet joints: illustrative case

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
J. Manuel Sarmiento ◽  
Daniel Chang ◽  
Peyton L. Nisson ◽  
Julie L. Chan ◽  
Tiffany G. Perry
Keyword(s):  
Cervical Spine ◽  
Motor Vehicle ◽  
Ct Scans ◽  
Occipital Condyle ◽  
Upper Cervical Spine ◽  
Illustrative Case ◽  
Facet Joints ◽  
Ligamentous Injury ◽  
Occipitocervical Fusion ◽  
Fusion Construct

BACKGROUND Patients who survive traumatic atlanto-occipital dissociation (AOD) may present with normal neurological examinations and near-normal-appearing diagnostic images, such as cervical radiographs and computed tomography (CT) scans. OBSERVATIONS The authors described a neurologically intact 64-year-old female patient with a degenerative autofusion of her right C4–5 facet joints who presented to their center after a motor vehicle collision. Prevertebral soft tissue swelling and craniocervical subarachnoid hemorrhage prompted awareness and consideration for traumatic AOD. An abnormal occipital condyle–C1 interval (4.67 mm) on CT and craniocervical junction ligamentous injury on magnetic resonance imaging (MRI) confirmed the diagnosis of AOD. Her autofused right C4–5 facet joints were incorporated into the occipitocervical fusion construct. LESSONS Traumatic AOD can be easily overlooked in patients with a normal neurological examination and no associated upper cervical spine fractures. A high index of suspicion is needed when evaluating CT scans because normal values for craniocervical parameters are significantly different from the accepted ranges of normal on radiographs in the adult population. MRI of the cervical spine is helpful to evaluate for atlanto-occipital ligamentous injury and confirm the diagnosis. Occipitocervical fusion construct may need to be extended to incorporate spinal levels with degenerative autofusion to prevent adjacent level degeneration.

Occipital Condyle Fractures

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A56-A59 ◽  
Author(s):  
Youssef R. Karam ◽  
Vincent C. Traynelis
Keyword(s):  
Computed Tomography ◽  
Clinical Presentation ◽  
Craniovertebral Junction ◽  
Diagnosis And Treatment ◽  
Occipital Condyle ◽  
Occipitocervical Fusion ◽  
Radiologic Evaluation ◽  
Serious Injury ◽  
Occipital Condyle Fractures ◽  
Prompt Diagnosis

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.

Cervical Spine Fractures in Athletes

1990 ◽  
Vol 9 (1) ◽  
pp. 13-29 ◽  
Author(s):  
Michael R. Marks ◽  
Gordon R. Reli ◽  
Francis R.S. Roumphrey
Keyword(s):  
Cervical Spine ◽  
Spine Fractures ◽  
Cervical Spine Fractures
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