- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Enyinna Nwachuku, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
DOI:10.25259/SNI_748_2021Copyright: © 2021 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: Enyinna Nwachuku, Confidence Njoku-Austin, Kevin P. Patel, Austin W. Anthony, Aditya Mittal, David Kojo Hamilton, Adam Kanter, Peter C. Gerszten, David Okonkwo. Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?. 19-Oct-2021;12:524
How to cite this URL: Enyinna Nwachuku, Confidence Njoku-Austin, Kevin P. Patel, Austin W. Anthony, Aditya Mittal, David Kojo Hamilton, Adam Kanter, Peter C. Gerszten, David Okonkwo. Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?. 19-Oct-2021;12:524. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11188
Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution.
Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma.
Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment.
Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.
Keywords: Arthrodesis, Fractures, Occipital condyle, Orthosis, Trauma
Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals sustaining cervical spine trauma.[
(a) A 42-year-old female motor cycle crash (MCC) with left Type II occipital condyle fracture with concomitant TBI, GCS 7T. (b) One-month interval CT cervical spine – a 42-year-old female MCC with left Type II occipital condyle fracture with concomitant TBI, GCS 7T with early signs of cortication of fracture line.
The current practice guidelines typically support management of patients with OCF with a cervical collar for approximately 6 weeks or longer.[
Here, we analyzed the rate of delayed surgical intervention (occipitocervical fusion) warranted in patients with isolated OCF who were managed with a rigid cervical collar for 6 weeks or longer at a high-volume Level 1 Trauma Center over a 10-year period.
All patients admitted to UPMC Presbyterian Hospital with OCF were analyzed from 2008 to 2018. All patients sustained an isolated traumatic OCF without other traumatic cervical injury [
Of the 1536 patients reviewed, 60 cases (4%) had OCF over the 10-year period [
Isolated OCFs are found in only 4% of cervical trauma series. At present, most individuals with OCF are managed with a cervical collar (external orthosis).[
In our cohort, no patient required surgery acutely or in delayed fashion to address occipitocervical instability or pseudoarthrosis. In addition, patients who were not limited by a TBI or other orthopedic injury were admitted and discharged with a normal neurological examination demonstrating that this fracture pattern poses very little to no risk of neurological injury in isolation.
Notably, rigid external cervical orthosis is associated with risk and complications that include aspiration pneumonia, limitation in driving, and/or other nonstrenuous activities of daily living, pressure ulcers, and cellulitis that can lead to bacteremia and possibly sepsis in vulnerable individuals.[
Sixty (4%) patients had isolated OCF out of 1536 patients presenting with traumatic cervical injuries, and none required acute and/or delayed occipital-cervical surgical fusions. Although historically, these fractures are primarily managed with an external cervical orthosis (C-collar), these findings provide a platform for prospective analysis comparing collar versus no-collar management for isolated OCF.
Patient’s consent not required as patients identity is not disclosed or compromised.
There are no conflicts of interest.
We would like to give gratitude to the University of Pittsburgh Medical Center for providing the cohort for this manuscript.
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