Abstract
An occipital condyle fracture (OCF) is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. For nondisplaced OCFs, conservative treatment is generally recommended, and there is no previous report of a nondisplaced OCF requiring surgery. We report a patient who had a nondisplaced OCF with craniocervical misalignment (a condyle-C1 interval > 2.0 mm) and C1-C2 translation treated with a halo vest and occipitocervical fusion surgery. An 87-year-old Asian woman fell from a 4-meter height and hit her head. She was transferred to our emergency room. Computed tomography revealed a nondisplaced impaction OCF with a 2.5 mm occipital condyle-C1 interval and a 5 mm C1-C2 translation. The fracture pattern was considered stable. However, since craniocervical misalignment and C1-C2 translation were present, the patient was placed in a halo device, and we reduced the occipitoatlantoaxial joint, adjusting the halo ring position preoperatively. Confirming reduction of the atlantooccipital facet joint and the atlantoaxial joint by computed tomography, we performed an occipitocervical fusion. This is the first report of a nondisplaced OCF with craniocervical misalignment and C1-C2 translation that required surgical treatment. Clinicians should be aware of craniocervical misalignment and atlantoaxial instability even in Tuli type 1 OCFs.
Highlights
An occipital condyle fracture (OCF) was once a relatively rare traumatic injury, but is increasingly diagnosed because of the wide availability of computed tomography [1, 2]
Our patient had craniocervical misalignment and a C1-C2 translation that required surgery. Her fracture pattern was exceptional for a Tuli type 1 fracture, for which conservative treatment is recommended
Tuli et al published the second classification for OCFs in 1997, which was aimed at being an efficient treatment guidance; they broadened the definition of instability to include the integrity of the atlantooccipital joint and of the atlantoaxial joint [3]
Summary
An occipital condyle fracture (OCF) was once a relatively rare traumatic injury, but is increasingly diagnosed because of the wide availability of computed tomography [1, 2]. Tuli et al reported a classification for OCF based on the stability of the O-C1-C2 complex [3]. In their classification, conservative treatment is recommended for type 1 fractures, which have a nondisplaced fracture or impaction fracture; a halo vest or surgical treatment is often recommended for type 2B fractures, which have a displaced fracture with ligamentous injury. We report the case of a patient who had a type 1 OCF with craniocervical misalignment and C1-C2 translation that was treated with a halo vest followed by occipitocervical fusion surgery. To the best of our knowledge, this is the first report of a type 1 OCF with craniocervical misalignment and C1-C2 translation that necessitated surgery
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