What is your diagnosis?

Occipital Condyle fracture, type II.

Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 87676. Annotation by author

• Pearl: Occipital condyles are oval shaped prominences of the occipital bone that form the lateral aspects of the foramen magnum. They form a paired articulation with the lateral masses of C1 to make the atlanto-occipital joint. Occipital-cervical stability is further increased by the alar ligaments, which connect the odontoid to the occipital condyles. 

How do you further classify this injury? Which injuries are considered stable?

Type I: Impaction fracture with comminution of the condyle. Stable [1]

Case courtesy of Dr Rajalakshmi Ramesh, Radiopaedia.org, rID: 33467. Annotation by author

Type II: Shear fracture that extends to a basilar skull fracture. Stable > Unstable [1-2]

Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 87675. Annotation by author

Type III: Avulsion fracture at the site of the alar ligament attachment. Unstable [1]

Case courtesy of Dr Alexandra Stanislavsky, Radiopaedia.org, rID: 18366. Annotation by author

• Pearl: Occipital condyle fractures are frequently associated with injuries to the cervical spine, brainstem, cranial nerves (IX, X, XI), and vertebral artery [2]

What is your management in the ED?

The patient should be placed in a cervical collar and maintained in strict spinal precautions. A spine surgeon should be consulted emergently as guided by institutional protocols. MRI can be obtained more urgently if neurologic symptoms are present. 

• Pearl: Management typically includes the following:
  • Type I  -> hard cervical collar for 8wks [1]
  • Type II -> hard collar vs halo immobilization vs occipital-cervical fusion [1-2]
  • Type III-> occipital-cervical fusion [1]