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  • Bilateral Occipital Condyle Fractures: Experience at a Level-1 Trauma Center

    Final Number:

    Robert Nicholas Hernandez MD; Arthur Carminucci MD; Ahmed M. Meleis MD; Charles J. Prestigiacomo MD FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Bilateral occipital condyle fractures (OCFs) are exceedingly uncommon. We aimed to identify patients with bilateral OCFs at a high-volume level-1 trauma center and report characteristics of presentation, associated injuries, and management.

    Methods: A retrospective chart review was conducted to identify patients with OCFs who presented to our institution between January 2000 and March 2016 after suffering trauma.

    Results: We identified 77 patients with OCFs, of whom 9 (11.7%) had bilateral fractures. The mechanism of injury was motor vehicle collision in 4 patients, fall down multiple stairs in 3 patients, crush injury in 1 patient, and pedestrian struck by moving vehicle in 1 patient. Of the 18 fractured condyles, 3 were type I, 6 were type II, 8 were type III, and 1 condyle had both a type II fracture and a type III fracture at two separate points. All patients reported or were witnessed to have loss of consciousness (LOC). Median Glasgow Coma Scale (GCS) at presentation was 15 (range 9-15). Six (66%) patients had other bony fractures and 3 (33%) patients had intracranial hemorrhages. Seven patients were treated with cervical collar immobilization and 2 patients were treated with halo vest application.

    Conclusions: Our series suggests that in patients who present after high-energy trauma with LOC, despite high GCS upon presentation, the presence of bony fractures and/or intracranial hemorrhage should prompt evaluation for fractures of the occipital condyles. Our data contributes to the existing scant body of literature on bilateral OCF.

    Patient Care: Our research contributes to the scant literature on bilateral occipital condyle fractures: the clinical presentation, associated traumatic injuries, and treatment options.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify patients at risk for occipital condyle fractures, 2) Identify clinical scenarios that should raise suspicion for occipital condyle fractures, 3) Identify other traumatic injuries associated with bilateral occipital condyle fractures, 4) Describe treatment options for bilateral occipital condyle fractures

    References: 1. Anderson PA, Montesano PX: Morphology and treatment of occipital condyle fractures. 1988. Spine 13:731-6. 2. Maserati MB, Stephens B, Zohny Z, Lee JY, Kanter AS, Spiro RM, Okonkwo DO. 2009. Occipital condyle fractures: clinical decision rule and surgical management. J Neurosurg Spine 11:388-95. 3. Karam YR, Traynelis VC. 2010. Occipital condyle fractures. Neurosurg 66 Supp 3:56-9. 4. Thodore N, Aarabi B, Dhali SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC, Hadley MN. 2013. Occipital condyle fracures. Neurosurg 72:106-113

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