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The coconut condyle: occipital condylar dysplasia causing torticollis and leading to c1 fracture

M A Halanski1, B Iskandar, B Nemeth

  • 1Department of Orthopaedics and Rehabilitation, University of Wisconsin, Clinical Science Center, Madison WI 53792, USA.

Journal of Spinal Disorders & Techniques
|June 17, 2006
PubMed

Insights

A child with congenital muscular torticollis sustained a C1 fracture after a fall, revealing a large occipital condyle as the likely cause of the initial head tilt and subsequent injury.

Area of Science:

  • Pediatric Orthopedics
  • Neurology
  • Developmental Pediatrics

Background:

  • Congenital muscular torticollis is a common condition in infants, typically presenting within the first month of life.
  • Traumatic injuries in children can exacerbate pre-existing conditions, leading to complex clinical presentations.
  • Occipital condyle anomalies are rare but can contribute to cervical spine instability and neurological symptoms.

Purpose of the Study:

  • To report a unique case of pediatric cervical spine fracture secondary to a fall in a patient with congenital muscular torticollis.
  • To investigate the potential link between occipital condyle morphology and the development of torticollis and C1 fractures.
  • To highlight the importance of thorough diagnostic workup in pediatric patients with worsening torticollis after trauma.

Main Methods:

  • Case report detailing a pediatric patient's clinical history, diagnosis, and management.
  • Review of imaging studies, including X-rays and CT scans, to assess cervical spine anatomy and identify fracture.
  • Clinical examination and assessment of neurological status.

Main Results:

  • A 22-month-old child with initial diagnosis of congenital muscular torticollis presented with acute worsening of head tilt and pain after a fall.
  • Radiographic evaluation revealed a C1 fracture and a disproportionately large ipsilateral occipital condyle.
  • The occipital condyle anomaly was identified as the probable cause of the initial torticollis and a predisposing factor for the C1 fracture.

Conclusions:

  • An unusually large occipital condyle may predispose children to congenital muscular torticollis and increase the risk of C1 fractures following minor trauma.
  • This case underscores the importance of considering underlying bony anomalies in the evaluation of pediatric torticollis, especially after injury.
  • Further research into the biomechanics of occipital condyle morphology and cervical spine stability is warranted.

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