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Age: 20

Sex: Female

Indication: Trauma

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Case #1


Findings

  • Displaced left occipital condyle fracture and widening and posterior offset of the right atlanto-occipital articulation. Displaced left occipital condyle fracture fragments narrow the anterior and left aspects of the foramen magnum
  • Right 1st and 2nd rib fractures with right greater than left apical pulmonary opacification
  • Partially imaged endotracheal tube


Diagnosis

  • Atlanto-occipital dislocation

Sample Report

Atlanto-occipital fracture/dislocation with a displaced left occipital condyle fracture and widening and posterior offset of the right atlanto-occipital articulation. Displaced left occipital condyle fracture fragments narrow the anterior and left aspects of the foramen magnum. Consider MRI without contrast to further evaluate the extent of ligamentous injury and to assess for cord trauma.

Right 1st and 2nd rib fractures with right greater than left apical pulmonary contusion and/or aspiration.


Discussion

  • Helpful numbers to know:
    • Occipital condyle to C1 Distance
      • <2 mm in adult
      • <4 mm in children
    • Tip of clivus to dens
      • <5 mm adult
      • <10 mm in child
    • Powers ratio
      • Basion to posterior C1 arch (a)
      • Opisthion to anterior C1 arch (b)
      • a/b >1 = worrisome for AO dislocation
  • Unfortunately, soft tissue algorithm sequences are not available for this case, but if you squint you can make out some extraaxial hemorrhage associated with the fractures (see annotated images)


Images

Blue arrow: displaced occipital condyle fracture. Blue arrow: displaced occipital condyle fracture. White arrow: widening of the right atlanto-occipital articulation. Red arrow: extra-axial hemorrhage posterior to the odontoid process. Diagram of helpful measurements to know. Sagittal view of the major cervical spine ligaments. Coronal view of the major ligaments at the craniocervical junction. Types of craniocervical dislocation.

Video Reviews

Cervical Spine Trauma

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