Outcome of conservatively treated occipital condylar fractures - A retrospective study

Occipital condyle fracture (OCF) is rare. It may, however, pose a serious threat to the patient due to destabilization of the craniocervical junction. Correct diagnosis and effective treatment are essential to prevent long-term complications. The aim of this study was to retrospectively investigate our current treatment program with focus on the functional outcome. Diagnosis and classification systems were evaluated for their usefulness in the clinical practice.

We retrospectively reviewed all patients treated conservatively for an occipital condylar fracture from 2010 to 2015 at our department. Fracture classifications were performed according to three established systems. The patients were followed up with clinical examination and plain radiographs at weeks 2, 6, and 12 with the addition of a dynamic flexion-extension X-ray at week 14.

Totally 24 patients met the inclusion criteria. One was lost to follow-up and two ended treatment before completing the full treatment program due to a clinical decision. Fracture displacement was neither detected nor was any neurological deficits observed. Most patients were pain free after 6 weeks. After 14 weeks' treatment, two patients still had neck pain; the rest were pain free.

Our data suggest that twelve weeks' conservative treatment is not necessary for unilateral OCFs without atlanto-occipital dissociation (AOD). We recommend 6 weeks of conservative treatment, with clinical control and flexion-extension radiographs before ending treatment. Plain radiography is of limited value in the clinical control of this fracture type. Anderson and Montesano and Tuli et al. classification systems fulfill an academic role. We found the classification system by Mueller et al. to be more helpful in everyday clinical practice.