title: Clival fractures in a level I trauma center.
abstract: OBJECTIVE
  Clival fracture (CF) is rare among head traumas. The aim of this study was to explore how radiological features observed in CF reflect the clinical picture and mechanism of injury in such cases.
  
  
  METHODS
  Radiological data for patients with skull base fracture admitted to the Montreal General Hospital between February 2002 and October 2012 were obtained from the Quebec Trauma Registry and reviewed for CF. Identified CF was categorized by orientation and quality. Injury mechanism, clinical presentation, and follow-up outcome were obtained through retrospective chart review.
  
  
  RESULTS
  Of the 1738 patients with skull base fractures, 65 exhibited CF, representing 1.2% of the 5416 patients with traumatic brain injuries admitted during the period studied. Thirty-nine (60%) of the 65 CFs were obliquely oriented, 17 (26.2%) were longitudinal, and 9 (14%) were transverse. Twenty-nine (45%) of the 65 patients demonstrated linear fracture, 17 (26%) hairline, 10 (15%) diastatic, and 9 (14%) displaced. Cranial nerve deficits and vascular injury occurred in 13.8% and 7.7% of cases, respectively. Twenty-five patients (38.5%) died in hospital. The long-term Extended Glasgow Outcome Scale score was significantly lower in transverse compared with longitudinal and oblique fractures (p = 0.03 and 0.03, respectively) and lower in diastatic compared with displaced fractures (p = 0.05).
  
  
  CONCLUSIONS
  This study provides information on the largest CF population studied to date, expands the current CF classification to include fracture quality as well as orientation, and underscores the existence of significant differences in pathogenesis and clinical presentation of CF subtypes.
authors.affiliation: Departments of 1 Neurology and Neurosurgery and.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winkler-Schwartz
authors.forename: José A
authors.initials: JA
authors.lastname: Correa
authors.forename: Judith
authors.initials: J
authors.lastname: Marcoux
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003388:Cranial Fossa, Posterior / Q000293:injuries*; D020209:Cranial Nerve Injuries / Q000150:complications; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012887:Skull Fractures / Q000145:classification* / Q000150:complications / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: CF = clival fracture; EGOS = Extended Glasgow Outcome Scale; GCS = Glasgow Coma Scale; IQR = interquartile range; ISS = Injury Severity Score; MVA = motor vehicle accident; TBI = traumatic brain injury; clivus; skull base; trauma