A 25 y.o. woman is brought to the ED after a high speed MVC, she has a GCS of 11 and appears to be intoxicated

What do you notice on her C-spine CT?

 hint it's near C1,C2

hint it's near C1,C2

Our patient had an occipital condyle fracture seen in the figure below.  Occipital condyle fractures are uncommon but can have fatal outcomes if missed. The first description of a death reported from  a missed fracture was in a patient who was being discharged and turned his head suddenly.  He arrested and autopsy showed a fracture of the occipital condyle which had been displaced into the brainstem. In large autopsy series of fatal car crashes, occipital condyle fractures have been reported at 4.2% .

occ conarr.jpg
occ con3.JPG

 Occipital condyle fractures are often seen  in association with palsies of the 12th cranial nerve due to fracture through the hypoglossal canal. Because of the proximity of the jugular foramen, nerves IX,X, and XI can also be involved. Delayed nerve damage has been reported up to nine weeks after the injury because of dislocation of bony fragments.

 A more obvious occipital condyle fracture.

A more obvious occipital condyle fracture.

Conservative management is the standard of care unless there is severe displacement of fragments. The duration of immobilization is three months.  Unstable fractures may be treated with a Halo or occipito-cervical fixation.   Interestingly, the MRI did not show the bony fragment but showed edema centered around the L occipital condyle and surrounding apical odontoid ligament and tectorial membrane consistent with an acute fracture.  There was no cord signal abnormality. Our patient was treated with a hard collar.

 

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