Occipital Condyle Fractures: Epidemiology, Classification, and Treatment Sabih T Effendi, Kevin C Morrill, Howard Morgan, David P Chason, Richard A Suss, Christopher J Madden Department of Neurosurgery University of Texas Southwestern Medical Center Dallas, TX
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Occipital Condyle Fractures: Epidemiology, Classification, and Treatment Sabih T Effendi, Kevin C Morrill, Howard Morgan, David P Chason, Richard A Suss,
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Occipital Condyle Fractures: Epidemiology, Classification, and
TreatmentSabih T Effendi, Kevin C Morrill, Howard Morgan, David P Chason,
Richard A Suss, Christopher J Madden
Department of Neurosurgery University of Texas Southwestern Medical Center
Dallas, TX
Disclosure Statement
• Nothing to disclose
History
• Sir Charles Bell (1817)• Rare entity• Increasingly diagnosed
– Imaging enhancements– Routine imaging
Middlesex Hospital Journal 4:469-470, 1817
REVIEW OF LITERATURE
Classification Systems• Anderson and Montesano (1988)
– Mechanism of injury → fracture morphology – Type I = comminuted –Type II = basilar skull fx
– Type III = avulsed
Spine 13: 731-736, 1988
Classification Systems• Tuli et al (1997)
– Type 1 = non-displaced– Type 2 = displaced (2A – stable, 2B – unstable)– Instability
• CT/Xray – subluxation OR MRI – avulsed transverse ligament
• Newer systems– A-M system– Stability assessment
• Hanson et al (2001) – bilateral O-C1-C2 joint complex injury• Malham et al (2009) – displaced fracture or malalignment of joint
Neurosurgery 41:368-377, 1997
American Roent Ray Soc 178: 1261-68, 2002Emergency Radiology Online, 2009
Treatment• Experience or non-radiographic outcome:
– wide range of treatments suggested
• Radiographic outcome data:– Capuano et al (2004)
• 10 pts, CT for fusion• All isolated OCF healed well with cervical collar
– Malham et al (2009)• 24 pts, CT for fusion and alignment & pain and disability scales• Isolated type I and II heal well with C collar• Isolated type III may benefit from halo vs collar
– Hard cervical collar, CTO, Halo-vest– 4 to 12 weeks
• None required surgery
TREATMENT & OUTCOME• 50 (69%) at initial follow-up
– No new neurological deficits
• 21 (29%) with flexion-extension films
TREATMENT & OUTCOME
• Type I and II
Number Radiographic stability Treatment Number FollowUp Flex-Exten
stable/obtained
24 (30%) All Stable
Cervical collar 20 3/3
Halo-vest 1+ -
Death before tx 3 -
TREATMENT & OUTCOME
• Type III, IorIII, IandIIINumber Radiographic
stability Number Treatment Number FollowUp Flex-Exten stable/obtained
55 (70%)
Stable 40 (73%)
Cervical collar 34 8/8
CTO 2 1/1
Halo-vest 1+ 0/0
Death before tx 3 -
Unstable 15 (27%)
Cervical collar 1 0/1
Halo-vest 13 8/8
Death before tx 1 -
CONCLUSIONS• High energy trauma, associated fractures• Modified A-M Classification System• Majority are type III• Stability
– Type I and II appear stable– Type III concerning for instability
• Treatment– None required surgery– Type I and II
• Hard cervical collar– Type III
• Stable – hard cervical collar• Unstable - halo
LIMITATIONS• Limited number with complete outcome data• Others
FUTURE INVESTIGATION• Assessing stability in type III fracture• Do all type I and II need collar immobilization?• Can some “unstable” type III be treated with collars?
Thank You• Dr. Christopher Madden• Dept of Neurosurgery at UT Southwestern