Bilateral occipital condyle fracture with clivus fracture: case report

Öz

Occipital condyle and clivus fractures caused by trauma are rare lesions that are difficult to diagnose. Only a few publications have reported cases involving both fractures. With the widespread use of high-resolution computed tomography in recent years, the diagnosis of these fractures has become more feasible; however, their clinical presentation and treatment approach remain uncertain for clinicians. The concurrent occurrence of occipital condyle and clivus fractures has recently been incorporated into the Anderson and Montesano classification system for occipital condyle fractures. In this paper, we aim to discuss the clinical presentation and treatment strategies of a 39-year-old female patient who was brought to our hospital with bilateral occipital condyle and transverse clivus fractures following a pedestrian traffic accident, in light of the existing literature.

Anahtar Kelimeler

• occipital condyle
• clivus
• fracture

Bilateral Oksipital Kondil Kırığı ile Birlikte Klivus Kırığı: Olgu Sunumu

Öz

Travma nedeniyle oluşan oksipital kondil ve klivus kırıkları nadir görülen ve tanı konulması zor lezyonlardır. Her iki kırığı birlikte bildiren çok az sayıda yayın vardır. Son yıllarda yüksek çözünürlüklü bilgisayarlı tomografinin yaygın kullanıma girmesi ile tanı konulabilen bu durumun kliniği ve tedavi yöntemi klinisyenler için hala belirsizdir. Oksipital kondil ve klivus kırığının birlikte görüldüğü bu durum oksipital kondil kırıklarını değerlendiren Anderson ve Montesano sınıflandırmasına yeni eklenmiştir. Biz burada 39 yaşında araç dışı trafik kazası nedeniyle gelişen bilateral oksipital kondil ve transvers klivus kırığı nedeniyle hastanemize getirilen kadın hastanın kliniğini ve tedavi yöntemlerini literatür eşliğinde tartışmayı amaçladık.

Anahtar Kelimeler

• Oksipital kondil
• klivus
• fraktür

Kaynakça

1. 1. Carriço G, Lam KS. A newtype of occipital condyle fractures - a case report and revision of literature is presented. Ann Sports MedRes 2022;9(1): 1186.
2. 2. Akar Ö, Yaldiz C, Özdemir N, Yaman O, Dalbayrak S. Isolated transverse clivus fracture without neurodeficit: case report and review of literature. Pol J Radiol 2015;19(80):151-154.
3. 3. Dashti R, Ulu MO, Albayram S, Aydin S, Ulusoy L, Hanci M. Concomitant fracture of bilateral occipital condyle and inferior clivus: what is the mechanism of injury? Eur Spine J 2007;16(3):261-264.
4. 4. Fuentes S, Bouillot P, Dufour H, Grisoli F. Occipital condyle fractures and clivus epidural hematoma. Case report. Neurochirurgie. 2000;46(6):563–567.
5. 5. Jones DN, Knox AM, Sage MR. Traumatic avulsion fracture of the occipital condyles and clivus with associated unilateral atlantooccipital distraction. AJNR Am J Neuroradiol. 1990;11(6):1181–1183.
6. 6. Maughan PH, Horn EM, Theodore N, Feiz-Erfan I, Sonntag VK. Avulsion fracture of the foramen magnum treated with occiput-to-c1 fusion: technical case report. Neurosurgery. 2005;57(3):E600. doi: 10.1227/01.neu.0000170989.90325.04.
7. 7. Tanabe M, Watanabe T, Matsumoto S, Okamoto H, Shirakashi K. Avulsion fracture of the anterior half of the foramen magnum involving the bilateral occipital condyles and the inferior clivus-case report. Neurol Med Chir (Tokyo) 1999;39(5):358–361. doi: 10.2176/nmc.39.358.
8. 8. Persad AR, Liu E, Wu A, Fourney DR. Bilateral occipital condyle fracture with an avulsion fracture of the foramen magnum: nonoperative care guided by a traction test. Illustrative case. J Neurosurg Case Lessons. 2023;6(25):CASE23577. doi:10.3171/CASE23577.

9. 9. Lam KS, Carriço G, Fernandes FM, Nanni F, de La Torre Escobar C. A rare case of bilateral occipital condyle fractures associated with inferior clivus separation fracture resulting incraniocervical dislocation: a case report and modification of the Anderson and Montesano classification is proposed. Acta Neurochir 2021; 163:2307-2311.
10. 10. Ucler N, Yucetas SC. Occipital condyle fracture extending to the inferior part of the clivus. Pediatr Neurosurg 2018;53(4):282-285.
11. 11. Chan JL, Cohen JD, Rahman SU, Perry TG, Tuchman A. Motion preserving management of unstable traumatic clivus fracture extending through bilateral occipital condyles. J Clin Neurosci 2020;80:257-260.
12. 12. Anderson PA, Montesano PX. Morphology and treatment of occipital condyle fractures. Spine (PhilaPa 1976) 1988;13:731-736.
13. 13. Mueller FJ, Fuechtmeier B, Kinner B, Rosskopf M, Neumann C, Nerlich M, et al. Occipital condyle fractures. Prospective follow-up of 31 cases within 5 years at a level 1 trauma centre. Eur Spine J 2012;21(2):289-94.
14. 14. Imamura O, Kojima T, Yashiki M, Namera A. Traumatic avulsion fracture of the occipital condyles and clivus: a case report. Legal Med 2000;2(1):49-53.