Occipital Condyle Fracture Extending to the Inferior Part of the Clivus

Üçler, Necati; Yücetaş, Şeyho Cem

doi:10.1159/000487512

Cited by 3 publications

(8 citation statements)

References 6 publications

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“…Conservative treatment options for OCF involve the use of rigid collar orthoses and Minerva braces. Orthoses and braces are applied in stable fractures, i.e., Anderson-Montesano types I, II, and rarely type III injuries and Tuli types I and IIA injuries [4,23,31]. Notably, Anderson-Montesano type III injuries occur in approximately 75% of patients suffering from OCF [24].…”

Section: Conservative Treatment Options For Ocfmentioning

confidence: 99%

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Treatment of Unstable Occipital Condylar Fractures in Children—A STROBE-Compliant Investigation

Tomaszewski

Gap²,

Lucyga³

et al. 2021

Medicina

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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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Section: Conservative Treatment Options For Ocfmentioning

confidence: 99%

“…Maserati et al mentioned the possibility of late surgical stabilization in patients initially treated non-operatively with cervical orthoses [12]. Karam & Traynalis emphasized the role of immobilization to achieve bone consolidation and recover peripheral nerve function [31].…”

Section: Operative Stabilization Of Ocfmentioning

confidence: 99%

Treatment of Unstable Occipital Condylar Fractures in Children—A STROBE-Compliant Investigation

Tomaszewski

Gap²,

Lucyga³

et al. 2021

Medicina

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“…Eight studies 4 , 5 , 12 , 14 , 17 – 20 described time from injury to initial management. Seven (77.8%) of these studies described immediate or in-hospital treatment within 24 h. 4 , 5 , 12 , 17 – 20 One study initiated treatment 1 day after the patient presented with progressive neck pain.…”

Section: Treatment Optionsmentioning

confidence: 99%

Section: Treatment Optionsmentioning

confidence: 99%

“…Post-management imaging was described by five studies. One study obtained CT prior to final halo removal, 4 two obtained CT to confirm fracture healing after completion of treatment course, 17 , 18 one obtained XR for this same purpose, 15 and one obtained flexion/extension cervical XR. 8 For patients who received halo vests, all underwent MRI within 9 days (median = 5.6 days, range = 3–9 days) of halo removal.…”

Section: Treatment Optionsmentioning

confidence: 99%

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Occipital condyle fracture in the pediatric population: A management algorithm and systematic review

Morcos,

Liu,

Farid

et al. 2024

Journal of Children's Orthopaedics

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Purpose: This study aims to develop an accessible stepwise management algorithm for pediatric presentations of occipital condyle fractures (OCFs) based on a systematic review of the published literature regarding diagnostic evaluation, treatment, and outcomes. Methods: A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric OCFs. Data extraction of clinical presentation, management strategies, imaging, and treatment outcome was performed. Results: A total of 15 studies reporting on 38 patients aged 18 years and younger presenting with OCFs were identified. Loss of consciousness (LOC), depressed level of consciousness, neck pain, decreased neck range of motion (ROM), and cranial nerve injury were the most common presenting symptoms. Diagnostic imaging included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), and functional radiographs to assess cervical stability. Treatment options varied and included soft collar, hard collar, and halo vest. All studies resulted in a complete healing of the OCF, with resolution of associated pain. Conclusion: The proposed treatment algorithm suggests a framework for the management of pediatric OCFs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a stepwise approach should be utilized in the management of isolated pediatric OCFs.

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Cranial Nerve Dysfunction in Patients with an Occipital Condyle Fracture: Underdiagnosis and Clinical Relevance

Thevis,

Derks,

Jansen

et al. 2024

J Neurol Surg B Skull Base

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Objectives This study aims to fill in the knowledge gap about patients with occipital condyle fractures (OCFs) and cranial nerve dysfunction (CND) and give advice about when to test the cranial nerves (CNs) and what to do when CND is diagnosed. Design A 14-year period observational, retrospective cohort study. Setting Level-I trauma center study. Participants All 119 surviving cases admitted with an OCF, whereof all 40 cases with either diagnosed CND (confirmed by clinical examination) or expected CND (reported observations high suspicious for CND) were selected for detailed data collection. Early death was the only exclusion criterion because of missing data and clinical irrelevance. Main Outcome Measures One-third of all surviving OCF patients have CND (n = 40/119, 33.6%), where three-quarters had more than one CN affected with a median of three CNs. Of the cases with a concomitant lateral skull base fracture (n = 24/40, 60%), one in three cases (36%, n = 13/36) had facial nerve palsy and nearly two in three cases (61%, n = 22/36) had hearing loss. Results The facial nerve was the most commonly diagnosed CND. Solitary OCF cases often had lower CND (n = 11/14). Fifty-eight percent of all CND cases with follow-up data (n = 19/33)—corresponding to one in six of all surviving OCF cases—had chronic CND sequelae. Conclusions Multiple and chronic CND is common in patients with an OCF. All CNs should be tested in those patients as soon as clinically possible, and testing should be repeated after 3 to 7 days and before discharge. Patients with CND should be counseled about their prognosis and be potentially referred to (e.g.) a speech and language therapist, ophthalmologist, neurologist, or otorhinolaryngologist for early treatment options.

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Occipital Condyle Fracture Extending to the Inferior Part of the Clivus

Cited by 3 publications

References 6 publications

Treatment of Unstable Occipital Condylar Fractures in Children—A STROBE-Compliant Investigation

Treatment of Unstable Occipital Condylar Fractures in Children—A STROBE-Compliant Investigation

Occipital condyle fracture in the pediatric population: A management algorithm and systematic review

Cranial Nerve Dysfunction in Patients with an Occipital Condyle Fracture: Underdiagnosis and Clinical Relevance

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