title: Management of an extended clivus fracture: a case report.
abstract: BACKGROUND
  Clivus fractures are highly uncommon. The classification by Corradino et al. divides the different lesions in longitudinal, transverse and oblique fractures. Longitudinal types are associated with the highest mortality rate between 67 - 80%. Clivus fractures are often found after high velocity trauma, especially traffic accidents and falls. The risk of neurologic lesions is high, because of the anatomic proximity to neurovascular structures like the brainstem, the vertebrobasilar artery, and the cranial nerves. Longitudinal clivus fractures have a special risk of causing entrapment of the basilar artery and thus ischemia of the brainstem.
  
  
  METHODS
  This lesion in our patient was a combination-fracture of the craniocervical junction with a transverse clivus fracture. In this case, the primary closed reduction of the clivus fracture and the immobilization with a halo device was the therapy of choice and led to consolidation of the fracture.
  
  
  CONCLUSIONS
  Therapy advices and examples in the literature are scarce. We present a patient with a clivus fracture, who could be well treated by a halo device. Through detailed research of the literature a therapy algorithm has been developed.
authors.affiliation: Department for Trauma-, Reconstructive- and Handsurgery, University Muenster, Albert-Schweitzer-Campus 1 Gebäude W1, Münster 48149, Germany. julia.evers@ukmuenster.de.
authors.forename: Julia J E
authors.initials: JJ
authors.lastname: Evers
authors.forename: Volker V V
authors.initials: VV
authors.lastname: Vieth
authors.forename: René R H
authors.initials: RR
authors.lastname: Hartensuer
authors.forename: Michael M J R
authors.initials: MM
authors.lastname: Raschke
authors.forename: Thomas T V
authors.initials: TT
authors.lastname: Vordemvenne
mesh_terms: D000328:Adult; D003388:Cranial Fossa, Posterior / Q000293:injuries*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male