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Radiologic and Clinical Spectrum of Occipital Condyle Fractures

Retrospective Review of 107 Consecutive Fractures in 95 Patients

¹ Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Ave., Box 359728, Seattle, WA 98104.
² Present address: Department of Radiology, Austin and Repatriation Medical Center, Austin Campus, Studley Rd., Heidelberg 3084, Australia.
³ Present address: One Union Square S., #20L, New York, NY 10003.

View larger version (42K): [in a new window]   Fig. 1A. —Line drawings show principal ligaments of craniocervical junction. (Drawings by B. J. Mortimer reprinted with permission from [29]) Lateral view of craniocervical junction shows tectorial membrane as continuation of posterior longitudinal ligament that attaches to anterior foramen magnum.

View larger version (41K): [in a new window]   Fig. 1B. —Line drawings show principal ligaments of craniocervical junction. (Drawings by B. J. Mortimer reprinted with permission from [29]) Posterior view of craniocervical junction shows paired alar ligaments passing from posterior surface of odontoid process to occipital condyles and minor component passing to C1 lateral masses.

View larger version (143K): [in a new window]   Fig. 2. —23-year-old man who was injured in fall from height. Axial CT scan shows type I Anderson and Montesano [13] impaction right occipital condyle fracture (arrow). D = dens.

View larger version (142K): [in a new window]   Fig. 3. —19-year-old man injured in motor vehicle crash. Axial CT scan shows type II Anderson and Montesano [13] right occipital condyle fracture extending through skull base (arrows). Note involvement of right hypoglossal canal (HC).

View larger version (154K): [in a new window]   Fig. 4A. —44-year-old man injured in motorcycle crash who sustained bilateral type III Anderson and Montesano [13] avulsion occipital condyle fractures. Axial CT scan shows bilateral parasagittal occipital condyle fracture (arrows).

View larger version (108K): [in a new window]   Fig. 4B. —44-year-old man injured in motorcycle crash who sustained bilateral type III Anderson and Montesano [13] avulsion occipital condyle fractures. Coronal CT reformation shows displaced bilateral occipital condyle fracture (arrows), with pathologic widening of left atlantoaxial joint (asterisk).

View larger version (117K): [in a new window]   Fig. 5. —25-year-old woman driver injured in high-speed rollover motor vehicle crash. Coronal CT reformation shows unilateral type III avulsion occipital condyle fracture (arrow) with widening of both occipitoatlantal and atlantoaxial joints (asterisks), which was equivalent to complete craniocervical dissociation.

View larger version (135K): [in a new window]   Fig. 6A. —19-year-old man ejected from automobile who sustained bilateral type III occipital condyle fractures. Coronal CT reformation shows partial ring fracture. Avulsion of anterior rim foramen magnum (arrows) is continuous with fractures shown in B.

View larger version (136K): [in a new window]   Fig. 6B. —19-year-old man ejected from automobile who sustained bilateral type III occipital condyle fractures. Coronal reformation shows both occipital condyle fractures (arrows).

View larger version (138K): [in a new window]   Fig. 7A. —50-year-old man injured in motor vehicle crash who sustained bilateral occipitoatlantoaxial joint complex disruption. Coronal CT reformation through occipital condyles shows moderate right (arrow) and small left (arrowhead) avulsion type III occipital condyle fractures.

View larger version (123K): [in a new window]   Fig. 7B. —50-year-old man injured in motor vehicle crash who sustained bilateral occipitoatlantoaxial joint complex disruption. Parasagittal CT reformation shows anterior subluxation of left occipitoatlantal joint (asterisk).

View larger version (134K): [in a new window]   Fig. 8A. —17-year-old girl injured in high-speed head-on crash with telephone pole who sustained bilateral type III avulsion occipital condyle fractures. Lateral radiograph shows marked increased prevertebral soft-tissue swelling but normal basion—dental (DB) and basion—axial (BP) intervals.

View larger version (155K): [in a new window]   Fig. 8B. —17-year-old girl injured in high-speed head-on crash with telephone pole who sustained bilateral type III avulsion occipital condyle fractures. Axial CT scan shows bilateral type III occipital condyle fractures (arrowheads).

View larger version (152K): [in a new window]   Fig. 8C. —17-year-old girl injured in high-speed head-on crash with telephone pole who sustained bilateral type III avulsion occipital condyle fractures. Sagittal CT reformation shows right occipital condyle fracture extending to basiocciput as partial ring fracture (arrow) to anterior foramen magnum.

View larger version (151K): [in a new window]   Fig. 8D. —17-year-old girl injured in high-speed head-on crash with telephone pole who sustained bilateral type III avulsion occipital condyle fractures. T2-weighted MR image shows increased signal in right occipital condyle (double asterisks) and confirms bilateral occipitoatlantal and atlantoaxial joint widenings (single asterisks), equivalent to complete craniocervical dissociation.

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