Treatment of a Displaced Occipital Condyle Fracture - A Case to be discussed

Abstract

Before the advent of computed tomography, occipital condyle injuries were solely a postmortem diagnosis. Nowadays, CT is well established in the diagnostic workflow of trauma management, allowing accurate planning and proper treatment. Anderson and Montesano as well Tuli developed radiologic classifications, each based on a small number of cases, in regards to the stability of the lesion and also provided treatment recommendations. In this case study we present a 24-year-old man suffering massive trauma to the head and thorax from a agricultural vehicle accident, leading to a displaced avulsion fracture of the right occipital condyle with high atlanto-occipital instability (Anderson Montesano type III). However, the patient did not develop any neurological deficit. Within the scope of the damage control polytrauma algorithm, the atlanto-occipital instability was initially stabilized in a HALO fixator. For devinitive treatment, we decided on an internal occipito-cervical fixation with a permanent fusion of the injured C0/C1-segment without reduction of the dislocated fragment at a time 14 days after the accident. The fixation construct spanned from the occiput to C3 in order to achieve a high primary stability. At 3-months follow-up, CT scans showed bony healing of the right condyle in an unchanged displaced position and a successful posterior fusion of C0/C1. After one year, a complete implant removal was done.