Radmard Mahla, Tafazolimoghadam Armin, Amoah Akua Afrah, Lakhani Dhairya A, Azad Tej D, Bydon Ali, Yousem David M
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 600 N. Wolfe Street, Phipps B100, Baltimore, MD, 21287, USA.
Tehran University of Medical Sciences, Tehran, Iran.
Emerg Radiol. 2024 Dec 5. doi: 10.1007/s10140-024-02303-4.
Occipital condyle fractures (OCFs) are classified by the Anderson and Montesano system into Type I (comminuted, minimally displaced), Type II (stable, associated with basilar skull fractures), and Type III (unstable avulsion fractures). We retrospectively analyzed 24,986 cervical spine CT examinations of emergency department patients over five years to determine the incidence and characteristics of OCFs, mechanism of injury, and associated intracranial and cervical spine injuries.
The study was IRB-approved and HIPAA compliant. We retrospectively reviewed the CT brain and CT cervical spine reports performed from July 2018 to August 2023. Variables collected included age, sex, clinical presentation, coincident brain and cervical spine injuries, treatments, and OCF classifications.
Sixty-three of 24,986 patients (0.25%) had OCFs, predominantly male (41 males, 22 females), with an average age of 51.1 years; 22/63 (34.9%) occurred in asymptomatic patients. Concurrent injuries included cervical spine fractures (33.3%) at C1 and C2 and intracranial injuries (47.6%), mostly subarachnoid and subdural hemorrhages. OCFs were categorized into Anderson-Montesano Type I (9 cases), Type II (24 cases), and Type III (30 cases), with unstable Type III fractures more common in MVC victims; stable fractures had higher rates of intracranial injuries. There were no significant differences in morbidity, mortality, or concurrent cervical spine or chest/abdominal/pelvic findings between stable and unstable OCFs.
The study highlights the importance of comprehensive imaging and evaluation in trauma cases to identify OCFs, even in asymptomatic patients, with a high rate of concurrent C1-2 and intracranial injuries.
CLINICAL RELEVANCE/APPLICATION: Being aware of occipital condyle fractures, types, and complications is important in the emergency radiology evaluation of trauma patients, especially given high rates of C1-2 fractures and intracranial bleeds.
枕髁骨折（OCFs）根据安德森和蒙泰萨诺系统分为I型（粉碎性、轻度移位）、II型（稳定型，与颅底骨折相关）和III型（不稳定撕脱性骨折）。我们回顾性分析了五年内急诊科患者的24986例颈椎CT检查，以确定枕髁骨折的发病率和特征、损伤机制以及相关的颅内和颈椎损伤。
本研究经机构审查委员会批准并符合健康保险流通与责任法案规定。我们回顾性审查了2018年7月至2023年8月期间的脑部CT和颈椎CT报告。收集的变量包括年龄、性别、临床表现、同时发生的脑部和颈椎损伤、治疗情况以及枕髁骨折的分类。
24986例患者中有63例（0.25%）发生枕髁骨折，男性居多（41例男性，22例女性），平均年龄为51.1岁；22/63（34.9%）发生在无症状患者中。并发损伤包括C1和C2颈椎骨折（33.3%）和颅内损伤（47.6%），主要是蛛网膜下腔和硬膜下出血。枕髁骨折分为安德森 - 蒙泰萨诺I型（9例）、II型（24例）和III型（30例），不稳定的III型骨折在机动车碰撞受害者中更常见；稳定型骨折的颅内损伤发生率更高。稳定型和不稳定型枕髁骨折在发病率、死亡率或并发颈椎或胸/腹/盆腔检查结果方面无显著差异。
该研究强调了在创伤病例中进行全面影像学检查和评估以识别枕髁骨折的重要性，即使在无症状患者中也是如此，因为同时发生C1 - 2和颅内损伤的发生率很高。
临床相关性/应用：了解枕髁骨折、类型和并发症在创伤患者的急诊放射学评估中很重要，特别是考虑到C1 - 2骨折和颅内出血的高发生率。
