Treatment of Unstable Occipital Condylar Fractures in Children-A STROBE-Compliant Investigation

Abstract

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.

Keywords: CT; MRI; children; halo vest; occipital condyle fracture.

Figure 1

CT scan (frontal plane) of a boy aged 15.2 years (Anderson–Montesano type III, Tuli type IIB injury; patient: P.P.) obtained after admission to the A&E room. Avulsed fragment of right condyle displaced medially by 4.0 mm.

Figure 2

CT scan (transverse plane) of a boy aged 15.2 years (patient: P.P.) obtained after admission to the A&E room. Avulsed fragment of right condyle displaced medially by 4.0 mm. Dislocation of odontoid to the left.

Figure 3

Control CT scan (frontal plane) of a boy aged 15.2 years (patient: P.P.) obtained after initiating halo-vest therapy and closed reduction of right-sided OCF. Correct alignment of condyle fragment on the right side and diminished fracture gap.

Figure 4

CT scan (frontal plane) of a boy aged 15.2 years (patient: P.P.) obtained after halo-vest therapy, showing bony consolidation of right-sided OCF in correct alignment.

Figure 5

MRI scan (frontal plane) of a boy aged 15.2 years (patient: P.P.) confirming union of right-sided OCF in correct alignment.