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Occipital condylar avulsion fractures in the acute trauma setting: Stable or unstable injury?

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Abstract

Background and purpose

Occipital condylar avulsion fractures are considered potentially unstable, associated with craniocervical dissociation spectrum injuries, and thought to carry a relatively high mortality rate based on the current literature. The purpose of this study was to identify patient with acute, occipital condylar avulsion fractures and evaluate for the incidence of concomitant cervical osteoligamentous trauma and craniocervical dissociation spectrum injury on cervical spine CT and MRI.

Materials and methods

Patients who suffered an inferomedial occipital condylar avulsion fracture were identified retrospectively using Nuance mPower software. Cervical spine CT and MRI reports performed within 48 h for this patient cohort were then reviewed by two CAQ certified neuroradiologists. Confirmation of an occipital condylar avulsion fracture was recorded along with any concomitant craniocervical junction injury. Relevant clinical history, including management and outcomes, was recorded for each patient.

Results

Thirty-four patients were identified with an inferomedial fracture of the occipital condyle. Of the 85% of patients who underwent cervical MRI, all but one patient demonstrated a ‘negative’ MRI without major craniocervical junction ligamentous injury. These patients were treated conservatively with external bracing without persistent neurologic deficits upon 4-month follow-up.

Conclusions

Inferomedial fractures of the occipital condyle are currently classified as potentially unstable fractures based on the Anderson classification system. Our data suggest that an isolated occipital condylar avulsion fracture without an additional C1–C2 fracture or widening of the atlanto-occipital joint space is likely a stable injury that can be treated conservatively with excellent clinical outcomes.

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References

  1. Offiah CE, Day E (2017) The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging 8:29–47. https://doi.org/10.1007/s13244-016-0530-5

    Article  PubMed  Google Scholar 

  2. Menezes A, Traynelis V (2008) Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). Child’s Nerv Syst 24:1091–1100

    Article  Google Scholar 

  3. Tubbs RS, Hallock JD, Radcliff V, Naftel RP, Mortazavi M, Shoja MM, Loukas M, Cohen-Gadol AA (2011) Ligaments of the craniocervical junction. J Neurosurg Spine 14(6):697–709. https://doi.org/10.3171/2011.1.SPINE10612

    Article  PubMed  Google Scholar 

  4. Iwanaga J, Sardi J, Voin V, Chapman JR, Oskouian RJ, Tubbs RS et al (2017) Anatomy of alar ligament part I: morphometrics and variants. World Neurosurg 107:1001–1006

    Article  Google Scholar 

  5. Riascos R, Bonfante E, Cotes C, Guirguis M, Hakimelahi R, West C (2015) Imaging of atlanto-occipital and atlantoaxial traumatic injuries: what the radiologist needs to know. Radiographics 35(7):2121–2134. https://doi.org/10.1148/rg.2015150035

    Article  PubMed  Google Scholar 

  6. Anderson PA, Montesano PX (1988) Morphology and treatment of occipital condyle fractures. Spine (Phila Pa 1976) 13(7):731–736. https://doi.org/10.1097/00007632-198807000-00004

    Article  CAS  Google Scholar 

  7. Osmotherly PG, Rivett DA, Mercer SR (2013) Revisiting the clinical anatomy of the alar ligaments. Eur Spine J 22(1):60–64. https://doi.org/10.1007/s00586-012-2496-4

    Article  PubMed  Google Scholar 

  8. Sunar M, Kapakin S (2019) Morphometric evaluation of craniocervical junction by magnetic resonance imaging method. Asian J Neurosurg 14(3):702–709. https://doi.org/10.4103/ajns.AJNS_293_17

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nidecker AE, Shen PY (2016) Magnetic resonance imaging of the craniovertebral junction ligaments: normal anatomy and traumatic injury. J Neurol Surg B Skull Base 77(5):388–395. https://doi.org/10.1055/s-0036-1584230

    Article  PubMed  PubMed Central  Google Scholar 

  10. Siddiqui J, Grover PJ, Makalanda HL et al (2017) The spectrum of traumatic injuries at the craniocervical junction: a review of imaging findings and management. Emerg Radiol 24:377–385. https://doi.org/10.1007/s10140-017-1490-x

    Article  PubMed  Google Scholar 

  11. Deliganis AV, Baxter AB, Hanson JA, Fisher DJ, Cohen WA, Wilson AJ et al (2000) Radiologic spectrum of craniocervical distraction injuries. Radiographics 20:S237–S250

    Article  Google Scholar 

  12. Chang YM, Kim G, Peri N, Papavassiliou E, Rojas R, Bhadelia RA (2017) Diagnostic utility of increased STIR signal in the posterior atlanto-occipital and atlantoaxial membrane complex on MRI in acute C1–C2 fracture. AJNR Am J Neuroradiol 38(9):1820–1825. https://doi.org/10.3174/ajnr.A5284

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tuli S, Tator CH, Fehlings MG, Mackay M (1997) Occipital condyle fractures. Neurosurgery 41(2):368–376. https://doi.org/10.1097/00006123-199708000-00006

    Article  CAS  PubMed  Google Scholar 

  14. Hanson JA, Deliganis AV, Baxter AB, Cohen WA, Linnau KF, Wilson AJ, Mann FA (2002) Am J Roentgenol 178(5):1261–1268

    Article  Google Scholar 

  15. Gire JD, Roberto RF, Bobinski M, Klineberg EO, Durbin-Johnson B (2013) The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. Spine J 13:510–519. https://doi.org/10.1016/j.spinee.2013.01.023

    Article  PubMed  Google Scholar 

  16. Dahdaleh NS, Khanna R, Menezes AH et al (2016) The application of the revised condyle-C1 interval method to diagnose traumatic atlanto-occipital dissociation in adults. Global Spine J 6:529–534. https://doi.org/10.1055/s-0035-1569058

    Article  PubMed  Google Scholar 

  17. Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, Ryken TC, Mielke DH (2002) Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg 49:407–498

    PubMed  Google Scholar 

  18. Hall GC, Kinsman MJ, Nazar RG et al (2015) Atlanto-occipital dislocation. World J Orthop 6(2):236–243. https://doi.org/10.5312/wjo.v6.i2.236

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kukreja S, Ambekar S, Sin AH, Nanda A (2015) Occipitocervical Fusion Surgery: Review of Operative Techniques and Results. J Neurol Surg B Skull Base 76(5):331–339. https://doi.org/10.1055/s-0034-1543967

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kwong Y, Rao N, Latief K (2011) Craniometric measurements in the assessment of craniovertebral settling: are they still relevant in the age of cross-sectional imaging?. AJR Am J Roentgenol. 196 (4): W421-

  21. Smith P, Linscott LL, Vadivelu S, et al (2015) Normal development and measurements of the occipital condyle-C1 interval in children and young adults. AJNR Am J Neuroradiol Oct 29. [Epub ahead of print] doi:https://doi.org/10.3174/ajnr.A4543 pmid:26514612

  22. Pang D, Nemzek WR, Zovickian J (2007) Atlanto-occipital dislocation, part 2: the clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery 61:995–1015. doi:https://doi.org/10.1227/01.neu.0000303196.87672.78

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Authors and Affiliations

  1. Department of Neuroradiology, University of Florida Health – Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Peter Fiester, Dinesh Rao & Erik Soule

  2. Department of Neurosurgery, University of Florida Health – Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Gazanfar Rahmathulla

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  1. Peter Fiester
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  2. Dinesh Rao
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  3. Erik Soule
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  4. Gazanfar Rahmathulla
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Correspondence to Peter Fiester.

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Fiester, P., Rao, D., Soule, E. et al. Occipital condylar avulsion fractures in the acute trauma setting: Stable or unstable injury?. Eur Spine J 30, 3128–3134 (2021). https://doi.org/10.1007/s00586-021-06949-3

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  • DOI: https://doi.org/10.1007/s00586-021-06949-3

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