Management of Type 3 Occipital Condyle Fracture

Introduction: Occipital condyle fractures (OFCs) can be seen in around 4-16% of patients who suffer from cervical spine trauma. Of these, Anderson and Montesano system Type III OCF, which is an avulsion fracture, is potentially thought to be unstable and operative. In this study, we looked at our institution's management of these fractures over a 22-year period.

Methods: This was a retrospective study looking at all patients with reported Type III OCF at our institution in their imaging reports. Using the in-house radiology imaging informatics system “Doris” (Dig Our Radiology Information System), all radiology reports from July 2001 to March 2023 with the phrase that included any combination of subluxation, avulsion, unstable, or type 3/III with occipital condyle, occipital condylar, occipital fx, or occipital fracture were collected. We additionally searched for any report with the phrase Montesano type III/3. Electronic medical records were used to collect clinical and demographic data. All patients who were evaluated by the neurosurgical team with at least 1 month follow up in our clinic were included for the study.

Results: 563 patients were identified to have type III OCF. 56 patients met criteria for inclusion. 92.8% of patients (52/62) were treated conservatively with cervical orthosis. 7.2% of patients (4/56) underwent occipitocervical fusion. 2 of the patients who underwent fusion was mainly for concomitant unstable C1 fracture. The other 2 patients who had occiput to cervical fusion had obvious coronal deformity associated with the type III OC fracture.

Conclusion : Type III OCF at our intuition have been managed mostly with cervical orthosis only. Only those with associated malalignment of the occipitocervical joint underwent fusion. These findings suggest that most type III OCFs can be treated conservatively with orthosis once stability is confirmed with upright radiographs.