A previously unrecognized connection between occipital condyle fractures and internal carotid artery injuries (carotid and condyles)

Excerpt

Occipital condyle fractures (OCF) were once considered rare, but are increasingly recognized with computed tomography [1]. Utilizing the classification scheme of Anderson and Montesano [2] proposed mechanisms include direct axial-loading of the skull onto the atlas (Type I), direct blow to the skull (Type II), or forced rotation (Type III). A fracture of the occipital condyles may suggest a specific pattern of injury to adjacent structures. The occipital condyles form the boundaries of the foramen magnum through which the medulla, vertebral arteries, and inferior cranial nerves pass. Injury to the occipital condyles places those structures at greatest risk. As the carotid arteries do not course near the occipital condyles, injury to them is generally unexpected in OCFs without concomitant craniocervical injuries. To date, there have been no published reports of carotid injuries associated with any type OCFs. We present two patients with isolated type III occipital condylar fractures in whom injury to the carotid arteries was present. …