Zeitschrift für Trauma und Behandlung

CT-Based Diagnosis of Occipital Condyle Fractures. A Prospective Evaluation With Reassessment of Fracture Morphology

Abstract

Mueller Franz, Rosskopf Michael, Goessmann, Holger and Fuechtmeier Bernd

Background: CT analyses of occipital condyle fractures (OCF) have been based on low case numbers so far, and prospective studies on fracture morphology are not available yet.

Methods: Over a period of five years, all OCF were prospectively assessed, and the patients were followed-up clinically and radiologically after one year post trauma.

Results: 31 patients were assessed of whom 27 had unilateral OCFs and 4 had bilateral OCFs; a total of 5 patients (16.1%) with OCF died due to the severity of associated injuries. Coronary CT reconstructions either showed horizontal or vertical fracture lines, with the latter extending into the joint (14 versus 17 patients). Mortality was 37.5% in patients with horizontal fractures (due to associated cerebral injuries) and 0% in patients with vertical fractures with joint involvement. The outcome at the time of clinical follow-up was also significantly worse with horizontal fractures.

Conclusions: OCFs per se are generally considered to be benign injuries. However, fracture morphology is an indicator for the clinical course: Due to related severe intracerebral injuries, horizontal fractures – when compared to vertical fractures – are associated with higher morbidity, significantly higher mortality, and significantly worse outcome