Vytautas Ragaišis, Evaldas Keleras


Occipital condylar fractures caused by high-energy blunttrauma to the craniocervical junction are very rare. It may lead toan incomplete understanding of the entity of this pathology andcan be underdiagnosed becouse this condition likely occurs withgreater frequency. The clinical presentation is highly variable:severe neck pain, caudal cranial nerve (IX-XII) palsy Collet-Sicardsyndrome, hemi or quadraparesis, symptoms of vertebrobasilarischemia. Brainstem and vascular lesions are fatal. The fracturein most of cases is not visible on a plain radiograph. CT has beenconsidered the method of choice. MRI is better for the assessmentof ligamentous structures (tectorial membrane and the transverseligaments of the atlas) and brain or brainstem. We report the caseof a 17-year-old boy who had an occipital condylar fracture withoutany associated neurological symptoms with severe neck pain after abicycle accident. The fracture was not visible on a plain radiograph.Only CT and MRI confirmed avulsion of the left condylar fragmentby the ipsilateral alar ligament. Apical ligament and tectorialmembrane were intact, complex O-C1-C2 was normal (Andersonand Montesano type III, Tuli IIA). Soft collar for 10 weeks wasused. Short and long-term results were very good.

Keyword(s): occipital condyle fracture, clinics, radiological diagnosis, treatment
DOI: 10.5200/sm-hs.2014.102
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