Contemporaneous avulsion fractures of the inferior clivus and bilateral occipital condyles with injury of the tectorial membrane
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky.
DOI:10.25259/SNI_599_2019Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Zaid Aljuboori, Mayur Sharma, Norberto Andaluz. Contemporaneous avulsion fractures of the inferior clivus and bilateral occipital condyles with injury of the tectorial membrane. 17-Jan-2020;11:11
How to cite this URL: Zaid Aljuboori, Mayur Sharma, Norberto Andaluz. Contemporaneous avulsion fractures of the inferior clivus and bilateral occipital condyles with injury of the tectorial membrane. 17-Jan-2020;11:11. Available from: https://surgicalneurologyint.com/surgicalint-articles/9841/
Background: Craniocervical junction (CCJ) injuries are highly variable, and there are only limited data to suggest their optimal treatment. Here, we present a rare case of concomitant bilateral occipital condyle fractures with an inferior clival avulsion fracture with concomitant focal injury of the tectorial membrane.
Case Description: Following a motor vehicle accident, a 51-year-old female sustained multiple orthopedic and soft tissue injuries. The cervical computed tomography (CT) showed a bilateral occipital condyle avulsion fractures with an avulsion of the inferior clivus. The cervical magnetic resonance imaging additionally demonstrated focal injury to the tectorial membrane with edema of both atlanto-occipital joints. Although the patient was neurologically intact, the CCJ instability warranted an emergent occiput-C2 (O-C2) posterior instrumented arthrodesis using the modular (multiple piece) occipitocervical (OC) plates/rods. The surgery was uneventful, and the patient remained neurologically intact. The 3-month follow-up cervical X-ray demonstrated continued stability/bony fusion.
Conclusion: Bilateral condyle fractures with a concomitant inferior clivus fracture are rare, and there is no known optimal strategy. Here, in an intact patient, instability of the CCJ warranted an O-C2 fusion.
Keywords: Clivus, Fracture, Fusion, Ligaments, Occipital condyle, Trauma
Unilateral or bilateral fractures of the occipital condyles with or without the involvement of the inferior clivus are uncommon and are challenging to treat.[
Here, we present a case of contemporaneous avulsion fractures of the inferior clivus and bilateral occipital condyles with focal tectorial membrane injury successfully treated with occipitocervical occiput-C2 (O-C2) fusion.
Following a motor vehicle accident, a 51-year-old female who presented neurologically intact with cervical magnetic resonance/computed tomography (CT) documented bilateral avulsion fractures of the occipital condyles (type III) and fracture of the inferior clivus [
The CCJ has multiple ligaments that provide support and stability.[
Isolated fractures with/without ligamentous injury can lead to instability of the CCJ and subsequently devastating vascular and/or neurologic complications. To assess both components, it is important to obtain an initial cervical CT and CT angiogram followed by a cervical MRI. Of note, 72 h after an injury, the tissue edema decreases, and ligamentous injury can be missed on MRI.[
There are not enough data to guide the selection between surgical and nonsurgical treatment for these injuries. Maughan et al.[
Bilateral occipital condyle fractures with inferior clivus fractures are rare, and there is no definitive treatment algorithm for these simultaneous lesions. Here, our patient with these multiple injuries and CCJ instability warranted an O-C2 fusion.
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