Management of an extended clivus fracture: a case report

Abstract

BackgroundClivus fractures are highly uncommon. The classification by Corradino et al. divides the different lesions in longitudinal, transverse and oblique fractures. Longitudinal types are associated with the highest mortality rate between 67 – 80%. Clivus fractures are often found after high velocity trauma, especially traffic accidents and falls. The risk of neurologic lesions is high, because of the anatomic proximity to neurovascular structures like the brainstem, the vertebrobasilar artery, and the cranial nerves. Longitudinal clivus fractures have a special risk of causing entrapment of the basilar artery and thus ischemia of the brainstem.Case presentationThis lesion in our patient was a combination-fracture of the craniocervical junction with a transverse clivus fracture. In this case, the primary closed reduction of the clivus fracture and the immobilization with a halo device was the therapy of choice and led to consolidation of the fracture.ConclusionTherapy advices and examples in the literature are scarce. We present a patient with a clivus fracture, who could be well treated by a halo device. Through detailed research of the literature a therapy algorithm has been developed.

Isolated Transverse Clivus Fracture without Neurodeficit: Case Report and Review of Literature

“…These complications are carotid artery occlusion and narrowing, carotid cavernous fistula, damage to the pericarotid oculosympathetic plexus, multiple nerve damage such as damage to the 6 th and 7 th cranial nerves, Horner syndrome, and pituitary dysfunction. The mortality rate of transverse fractures is lower than that of other types of clival fractures [ 1 , 11 , 12 ]. Our case had no other fracture and had normal vascular structures as determined by CT angiography and bone window CT.…”

Contemporaneous avulsion fractures of the inferior clivus and bilateral occipital condyles with injury of the tectorial membrane

“…Of note, 72 h after an injury, the tissue edema decreases, and ligamentous injury can be missed on MRI. [2,3,[5][6][7][8][9][10][11][12] Surgical considerations ere are not enough data to guide the selection between surgical and nonsurgical treatment for these injuries.…”

“…Unilateral or bilateral fractures of the occipital condyles with or without the involvement of the inferior clivus are uncommon and are challenging to treat. [1][2][3]5,7,12] is type of injury can be highly unstable due to the involvement of the atlanto-occipital joint (AOJ) and ligaments that stabilize the craniocervical junction (CCJ). [2,3,7,12] Here, we present a case of contemporaneous avulsion fractures of the inferior clivus and bilateral occipital condyles with focal tectorial membrane injury successfully treated with occipitocervical occiput-C2 (O-C2) fusion.…”