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.
Highlights
We present a patient with a clivus fracture, who could be well treated by a halo device
Clivus fractures are often found after high velocity trauma, especially traffic accidents and falls [3,4]
Longitudinal clivus fractures have a special risk of causing entrapment of the basilar artery and ischemia of the brainstem [3]
Summary
Clivus fractures are highly uncommon [1,2]. The classification by Corradino et al [2] divides the different lesions in longitudinal, transverse and oblique fractures. Case presentation A 43-year-old polytraumatized male patient was admitted in May 2009 to our clinic He had fallen off a scaffolding, which was 4 meters high. The computed tomography (CT) scan revealed the following injuries: Dislocated clivus fracture – transverse type [2], extending into the left occipital condyle (Figure 1, Figure 2, Figure 3). The patient was brought to the operating theatre, where a closed reduction of the clivus fracture under manual traction and c-arm control was performed. After 12 weeks of immobilization the follow-up CT-scan showed a sufficient bony bridging of the clivus fracture and the halo fixation was removed Figure 6. A final conventional angiography of the vertebral artery could no longer detect a dissection and the anticoagulation was stopped 6 months after trauma. After rehabilitation the patient was re-integrated back into his trained profession Figure 7
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