Occipital Condyle Fractures

Occ condyle Type II




4% of cervical spine fractures





- Occipitoatlantal joint (C0/C1)

- poor bony congruency, relies on ligamentous stability



- Alar ligaments: Strong ligaments connecting odontoid to occipital condyles

- Apical ligament: Weak ligament, connecting apex of odontoid to foramen magnum

- Tectorial membrane: Continuation of PLL connecting posterior body of axis to forament magnem




Compression / lateral compression


High association with blunt force trauma

- seen in association with other cervical and orthopedic injuries

- high association with significant head injuries


West et al World Neursurg 2018

- 46 patients with occipital condyle fractures

- 30% had intra-cranial injuries

- 43% had significant other cervical spine injuries




Skull base pain


Cranial nerve injury / hypoglossal nerve injury

- hypoglossal canal in close proximity

- slurred speech, difficulty swallowing

- can be delayed presentation


Classification Anderson & Montesano


Occ IOcc Type IIOcc III

Type Description Management
Type I Condyle impaction without displacement Collar
Type II Condyle fracture associated with basal skull fracture / involvement of the foramen magnum Collar
Type III Infero-medial condyle avulsion fracture secondary to alar ligaments Halo-thoracic brace

Hanson et al AJR 2002

- 95 patients with 107 occipital condyle fractures

- 77% unilateral occipital condyle fractures

- 75% type III

- associated cervical spine injuries seen in 31%

- 10/95 died




Frequently misses this injury




Occ condyle Type IIOcc condyle Type II Occ condyle Type II

Type II:  Occipital condyle fracture involving base of skull


Occ type 1 1 Occ Type 1 2

Type III:  Inferomedial alar ligament avulsion


Occ Type 2Type II occipital condyle

Type II: Basal skull involvement




External immobilization


Musbahi et al Clin Neurol Neurosurg

- systematic review of 25 studies and 239 patients

- all treated in halo or collar for 3 months

- mortality rate 40% from other injuries


Maserati et al J Neurosurg Spine 2009

- follow up of 104 occipital condyle fractures

- occipital-cervical (C0-C3) fusion in 2 who had evidence of craniocervical malalignment

- remainder all treated with collar

- no late instability / malalignment / nerve compression


Type I / II





Type III




Potentially unstable


Fiester et al Eur Spine J 2021

- 34 patients with infero-medial Type III occipital condyle fracture

- MRI stable in all but one patient




? Halo-thoracic brace




Maddox et al Spine 2012

- 28 patients with occipital condyle fractures treated nonoperative

- mean Neck Disabilty Index was 14 (mild disability)

- headache most common symptom