Trauma to the Back of the Neck

"Trauma to the Back of the Neck"

Author: BuMin Kong, MD; Susie Lee, BA

Peer-Reviewer: Mark Hopkins, MD

Final Editor: Alex Tomesch, MD

50yr old male presents with neck pain after being hit from behind with a beer bottle. He has no neurological deficits. CT is shown below.

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

1. What is your diagnosis?

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

3. What is your management in the ED?

-- See below for answers --

1. 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. 

2. 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]

3. 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]

Reference

1. Egol K, Koval, KJ, Zuckerman JD. Handbook of Fractures. Lippincott Williams & Wilkins. 2010 ISBN: 160547760

2. Karam YR, Traynelis VC. Occipital condyle fractures. Neurosurgery. 2010 Mar;66(3 Suppl):56-9. doi: 10.1227/01.NEU.0000365751.84075.66. PMID: 20173528.

Sign up here to receive our weekly cases

Want to write? Email us at orthoempearls@gmail.com

Instagram/Twitter: @orthoempearls

www.orthoempearls.blogspot.com