title: Fractures of the occipital condyle clinical spectrum and course in eight patients.
abstract: BACKGROUND
  Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs.
  
  
  METHODS
  All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years).
  
  
  RESULTS
  Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only.
  
  
  CONCLUSIONS
  OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany.
authors.forename: Antonio
authors.initials: A
authors.lastname: Krüger
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Oberkircher
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Frangen
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kühne
authors.affiliation: Department of Trauma and Hand Surgery, Hospital of the Brothers of Mercy, Trier, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Junge
keywords: Long-term outcome; multiple trauma; occipital condyle fracture
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