OCCIPITAL BONE FRACTURE SERIES
The high incidence of severe head trauma in patients with OCF is mainly described in autoptic series that collect cases associated with fatal atlanto-occipital dislocations or avulsion fractures. In 1992, Bozboga and co-workers were the first to report the surgical treatment of an OCF. The first description of OCF was given in 1817 by Bell. Data about the survival were not available for 67 patients, but in the 59 remainder patients quoad vitam prognosis was good. Only two patients died: one presented a brainstem injury secondary to a displaced OCF and the other patient had a clival fractures with brainstem infarction. In five patients a surgical decompression was performed, and in one of these patients also an occipito-cervical fixation was performed. Only six of the 43 patients with lower cranial nerve involvement had a complete recovery, 19 had a partial recovery, five remained stable, and for 13 patients follow-up was not given. Collet–Sicard syndrome was present in eight cases. Early or delayed involvement of lower cranial nerves was present in 43 (40%) patients. Of the patients with impaired of consciousness, 12 (26%) presented associated intracranial lesions (five subdural hematoma, five ponto-bulbar or cerebral contusion, three epidural hematoma, one brainstem infarction). Twenty-two patients were comatose or had GCS ≤8. Loss of consciousness for a short time occurred in 15 (14%) patients. Fifty-five patients were awake on admission or had minor disturbances (54%) 46 patients had impaired consciousness (45%). Mean age was 32.3 years (range 3–88 years).įor 20 patients, information was not provided about clinical condition on admission.
This male prevalence is consistent with the epidemiologic data of trauma. A high level of suspicion is fundamental for the early diagnosis of these fractures, so that when a posterior basal cranial or occipital squama fracture occurs, a CT study of the occipital condyles becomes imperative.Īnalysis of the data from literature and our small series We want to emphasize that not only an OCF with instability of O–C1–C2 can be a fatal injury unless prompt surgical intervention, but a displacement and migration of the fractured condylar fragment can also result in a fatal outcome. Immobilization provides good recovery of most OCFs, but delay of treatment can lead to serious morbidity. However, quoad vitam prognosis of patients with “pure OCFs” remains good. Rarely patients with a deficit of the lower cranial nerves make a complete recovery. We analyzed 121 cases of OCF (116 from the literature and five of our own). Early recognition of some types of OCF is imperative to avoid fatal results. After the advent of CT, prompt diagnosis can be readily made and consequently better prognosis of these patients is expected. Occipital condyle fractures (OCFs) are uncommon and potentially fatal lesions.
0 kommentar(er)
