Occipital condyle fractures in the pediatric population

Abstract

Background: The purpose of this study was to determine associated injuries and outcomes in children with occiptal condyle fracture (OCF). Methods: From review of medical records, children with OCF were identified. Demographics, length of stay, Glasgow Coma Scores (GCS), associated injuries, and outcomes were collected. The Anderson-Montesano classification system was used to define the fracture patterns. Results: Of 587 children with a base of the skull fracture, only 13 with OCF were identified (10 type II; three type I). All patients were treated nonoperatively except one patient who had an atlantooccipital dislocation. Associated injuries included scalp contusion, concussion, cerebral edema, neck injury, thoracic trauma, abdominal trauma, and appendicular skeletal fracture. Complications noted within 2 months included tinnitus in three patients and hearing loss in one. One patient had convulsions and syncope 2 years after injury. One patient had difficulties with temperature regulation and bladder control, inability to sweat, headaches, comprehension difficulty, weakness, and tremor 3 years after the accident. One patient was lost to follow-up. Conclusions: OCF is rare in children but is associated with head, thoracic, and abdominal trauma. Type I and II fractures predominate. Although operative treatment rarely is necessary, it is required in patients with atlantooccipital dislocation. Ligamentous structures should be assessed with MRI.