Avulsion Fracture of the Foramen Magnum Treated with Occiput-to-C1 Fusion: Technical Case Report

Abstract

This rare injury, a bony variant of occipitoatlantal dislocation, was successfully treated with a unique occiput-to-C1 fusion.

Concomitant fracture of bilateral occipital condyle and inferior clivus: what is the mechanism of injury?

“…According to our knowledge, apart from the present report, there are only five cases reported previously [8,[12][13][14][15] (see Table 1). The first reported case of bilateral OCF with extension to clivus by Jones et al [13] was quadriplegic and treated by posterior fusion procedure at the fourth week of his admission.…”

“…However, there are no widely accepted treatment guidelines [9,14]. Although successful treatment of bilateral OCFs with cervical collar has been reported [4] more rigid fixation is warranted if a concomitant clivus fracture is identified.…”

“…Imamura et al [12] surprisingly reported occipito-cervical instability in their autopsy case in spite of intact transverse and alar ligaments and the tectorial membrane. Maughan et al [14] recently reported their patient treated by a new technique of occipito-C1 fixation rather than the typical surgical method of occipito-C2 or below fixation. Another re- ported occurrence of a rare combination of an avulsion of both the right occipital condyle and clivus and a fracture of the left lateral mass of the atlas was treated with a cervical collar [11].…”

Management of an extended clivus fracture: a case report

“…A more unstable injury of the craniocervical conjunction like reported by Maughan et al [11] with an avulsion fracture of the foramen magnum with bilateral fractures of the occipital condyles, and extension into the inferior clivus attained good results with an occipito-cervical fusion.…”

Occipitocervical Vertical Distraction Injuries

“…MRI demonstrating alar ligament orientations in representative specimens from OAD and AAD groups. Treatment and fixation strategies can be based on these findings since surgical fixation techniques exist for isolated occipitoatlantal fixation 25,26 and isolated atlantoaxial fixation. In a specimen that was to fail as AAD, the left and right orientations were typically symmetrical (arrows).…”