Case Of Occipital Condyle Fracture Research Articles

Fractures of the occipital condyle clinical spectrum and course in eight patients.

Introduction:Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs.Materials and Methods:All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years).Results:Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only.Discussion:OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar.

Occipital Condyle Fracture with Associated Hypoglossal Nerve Injury

Occipital condyle fracture (OCF) is a rare injury that was first described by Bell in 1817. In fact, there have been only 96 more reported cases of occipital condyle fractures from 1817 to 1994 of which only 58 survived. Occipital condyle fractures can sometimes go unnoticed or under-diagnosed as they are not always evident on plain radiographs of the cervical spine. Also, in rare cases OCFs can cause damage to the hypoglossal nerve which passes through the hypoglossal canal which is near the occipital condyle. The presence of specific symptoms and clinical signs should lead to the correct diagnosis. This paper describes a patient who was diagnosed with OCFs, but not hypoglossal nerve damage until 20 days following admission to hospital. We point out many factors that contributed to this delayed diagnosis, which ultimately caused severe discomfort to the patient.

The complexity of trauma to the cranio-cervical junction: correlation of clinical presentation with Doppler flow velocities in the V3-segment of the vertebral arteries.

Trauma to the craniocervical junction (CCJ) encompasses a wide and complex spectrum of injury with an even broader range of clinical presentation, and since trauma to this area borderlines neurosurgical main areas of interest, these relatively rare injuries can be overlooked. In fact, there has been an abundance of documentation in the literature since Sir Charles Bell first reported on a case of occipital condyle fracture in 1817 in which a patient suddenly dropped dead as he turned his head to thank physicians and nurses while leaving the hospital. The death was attributed to compression of the medulla oblongata by a fractured occipital condyle. At our department, we have been applying specialized diagnostic procedures in our clinical work-up in the acute and chronic situation of isolated injury to the CCJ as well as polytrauma with CCJ involvement in a total of 33 patients throughout a 3-year period (1997 to 2000). In this article, we present some of our experiences with these diagnostic procedures, introducing the application of V3-segment Doppler of the vertebral artery (VA), which we consider to be an effective supplementary method in a precise work-up in CCJ injury. The V3-segment of the vertebral artery, especially where it courses through its' groove behind the superior facet of the atlas is particularly vulnerable to injury. The authors measured flow velocity of the V3-segment from a point just below and roughly 2 to 3 centimeters dorsal to the mastoid process. All patients were investigated for the occurrence of changes in the blood flow in the V3-segment of the VA after suffering a CCJ injury. There was an increase or decrease in the flow velocity in trauma patients with whiplash injuries as well as in patients with occipital condyle fractures and associated ligament injury. In severe injuries, some with fatal outcome, a dissection or thrombosis of the VA was found with a loss of the V3-doppler flow signal, or rather flow void. CCJ injuries in the polytrauma patient as well as in patients presenting with delayed onset of symptoms often remain unrecognised, despite the advances in medicine. CCJ injuries are potentially lethal and can be treated if detected early. The V3 method enables rapid, effective, feasible and inexpensive diagnosis in the initial work-up of CCJ-injury.

OCCIPITAL CONDYLE FRACTURE MUST BE CONSIDERED IN THE PEDIATRIC POPULATION

To our knowledge, no case of occipital condyle fracture after minor head trauma in the pediatric population has been published. We report the case of a 12-year-old girl with a Jefferson's fracture detected on x-ray films. Axial high resolution computed tomography and coronal reconstruction images demonstrated the additional occipital condyle fracture.

Primary dural melanomas

Fracture of the occipital condyle is a rare problem. Diagnosis requires a high index of suspicion in a patient with a head injury and abnormalities of function of the lower cranial nerves. The diagnosis is best made by high resolution computed tomographic scanning with sagittal and coronal reconstructions. Although transoral and lateral surgical approaches for decompression and stabilization are possible, these are difficult and frought with danger. We report a case of occipital condyle fracture in which operation was deferred and spontaneous recovery occurred, as has happened in previous cases. (Neurosurgery 15:101-103, 1984)