Fractures of the occipital condyles are a relatively rare injury that occur in high energy blunt mechanisms (IE roll over MVC) most commonly. Physical exam will show signs of basilar skull fracture and significant pain at the base of the skull/upper C-spine. CT scan is the gold standard to make the diagnosis. Look for signs of upper extremity weakness on physical exam or cranial nerve injuries. Those type of findings should also prompt emergent MRI evaluation. Treatment generally is long term immobilization in a collar however Type 3 and those with neurologic findings may require surgical intervention.
Anderson and Montesano Classification
Type I 3% of occipital condyle fracturesImpaction-type fracture with comminution of the occipital condyle
Due to compression between the atlantooccipital joint
Stable injury due to minimal fragment displacement into the foramen magnum
Type II 22% of occipital condyle fracturesBasilar skull fracture that extends into one or both occipital condyles
Due to a direct blow to skull and a sheer force to the atlantooccipital joint
Stable injury as the alar ligament and tectorial membrane are usually preserved
Type III 75% of occipital condyle fractures Avulsion fracture of condyle in region of the alar ligament attachment (suspect underlying occipitocervical dissociation)
Due to forced rotation with combined lateral bending
Has the potential to be unstable due to craniocervical disruption
