Occipitale Condylenfrakturen – Eine retrospektive Kohortenstudie: Therapie und Follow-Up

Traumatic occipital condyle fractures (OCF) are infrequent injuries associated with severely injured trauma patients. High-level evidence for treatment is lacking. The aim of our study was to examine treatment modalities and outcome within a large cohort.

After retrospective patient selection from our radiological database within a 10-year period, fracture type, treatment modality as well as clinical features at admission and follow-up were documented by medical chart review. Descriptive and bivariate statistics were used to define cohort variables and check for associations. Data of 152 patients were included in our analysis. Mean follow-up was 6 weeks.

43% of patients were treated using a semi rigid collar with lower jaw inclusion, 3.3% received surgical treatment (1.5% Halo fixation and 1.8% internal fixation.) 12% of cases received a soft collar and 40.8% did not receive documented treatment. All patients treated surgically had associated upper cervical spine fractures. We observed no spinal cord injury at the occipitocervical junction.

Anderson and Montesano Type II fractures were left untreated significantly more often than other fracture types. No Type II fracture was treated surgically.

At follow-up 41% of patients with initial focal neurological deficits had no neurological deficits and 55.7% of patients with neck pain at admission were pain free.

Follow-up imaging was conventional radiography in 63% of cases whereby OCF could not be clearly delineated in 76% of cases. Secondary dislocation was observed in 0.8% of cases.

A clear statement on OCF treatment and neurological outcome cannot be made, as neurological impairment was more likely due to concomitant injuries rather than C0 injury.

Our study shows that not all fracture types are treated equally despite clear recommendations. Further investigation into fracture stability must therefor be made if one fracture type is disadvantaged therapeutically. Plain radiography as a follow up imaging must be reevaluated as fractures are seldom identified in this imaging technique.