Tuli

C0 (occipital condylar) fractures

Type 1

Undisplaced. Stable, requires no immobilisation.

Type 2

Displaced. Requires further information on craniocervical joint instability.

Check on X-ray or CT for:

• >8 degrees axial rotation C0-C1 to one side
• >6mm C0-C1 translation (between basion and odontoid process)
• >7mm overhang C1 on C2
• >45 degrees axial rotation C1-C2 to one side
• >4mm C1-C2 translation
• <13mm distance between posterior body C2 to posterior ring C1

And/or on MRI for:

• transverse ligament disruption

Then determine subtype:

• Type 2A

  None of these present = stable. Can be treated with hard collar.

• Type 2B

  One or more of these present = unstable. Treat with Halo-vest or surgical fixation.

Reference

Leone et al. Occipital condylar fractures: a review. Radiology (2000) vol. 216 (3) pp. 635-44

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