Occipital Condyle Fracture

Fractures of the occipital condyle are a rare consequence of trauma.

Historical Background

The first fracture of the occipital condyle was described by Bell in 1817 in an autopsy case¹.

Epidemiology

Fractures of the occipital condyle occur in approximately 0.4% of trauma patients², with a median patient age of approximately 32 years, and occur twice as frequently in male as in female patients³.

Clinical Presentation

Typically, patients experience pain in the occipitocervical region⁴. A torticollis may also result from the fracture. Due to the proximity of the occipital condyle to the lower cranial nerves, patients with an occipital condyle fracture may also develop deficits of the lower cranial nerves, such as hypoglossal nerve palsy. Of the lower cranial nerves, the hypoglossal nerve is most frequently affected⁵.

Imaging

The gold standard for the diagnosis and assessment of an occipital condyle fracture is CT imaging⁶.

Enlarge

MRI is optimal for assessing the integrity of the ligamentous structures of the craniocervical complex.

Classification

Occipital condyle fractures are classified according to the Anderson and Montesano classification.

Treatment

According to the AANS/CNS Guidelines, all occipital condyle fractures should be treated with immobilization of the cervical spine to promote bony fusion and prevent the development of cranial nerve deficits⁷. Surgical treatment in the form of occipitocervical stabilization may be considered in the following cases ^{8 9 10}:

• Bilateral fracture of the occipital condyle.
• Clinical or radiological evidence of occipitoatlantal or atlantoaxial instability.
• Decompression of a fracture fragment.

References