Occipital condyle fractures

Neurosurgery. 1997 Aug;41(2):368-76; discussion 376-7. doi: 10.1097/00006123-199708000-00006.


Objective: Occipital condyle fractures (OCFs) are infrequently recognized. Three recent cases of OCF in our center prompted a review of the incidence, clinical presentation, diagnosis, and treatment of this entity.

Methods: A retrospective review of medical records and radiographic results was performed for 93 of 316 consecutive patients who were victims of trauma, who presented at the Toronto Hospital during a 13-month period, and who had undergone computed tomography of the occiput.

Results: A review of the literature regarding OCF revealed that cranial nerve deficits occurred in 31% of the patients with OCFs; of those, the deficits were delayed in 38%. Three new cases of OCF, with neck pain but without cranial nerve deficits, have been reported. The cervical spine x-rays revealed nothing abnormal in 96% of the reported cases. In our retrospective review, asymptomatic OCF was revealed by computed tomography for 1 of the 93 patients.

Conclusion: OCF is a diagnostic challenge. We suggest that computed tomographic scans of O-C2 be obtained in the following circumstances: presence of lower cranial nerve deficits, associated head injury or basal cranial fracture, or persistent severe neck pain despite normal radiographic results. We propose a new classification system for the management and treatment of OCF based on the stability of the O-C1-C2 joint complex reflected by the presence of displacement of the condyle, computed tomographic or radiographic evidence of O-C1-C2 instability, and magnetic resonance evidence of ligamentous injury. OCFs are divided into the following types: Type 1 (stable), undisplaced fracture; Type 2A (stable), displaced fracture with no ligamentous instability; and Type 2B (unstable), displaced fracture with ligamentous instability.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Anatomy, Artistic
  • Female
  • Humans
  • Incidence
  • Medical Illustration
  • Middle Aged
  • Occipital Bone / injuries*
  • Retrospective Studies
  • Skull Fractures / diagnosis*
  • Skull Fractures / epidemiology
  • Skull Fractures / therapy*
  • Tomography, X-Ray Computed*