Contemporaneous avulsion fractures of the inferior clivus and bilateral occipital condyles with injury of the tectorial membrane

Background: Craniocervical junction (CCJ) injuries are highly variable, and there are only limited data to suggest their optimal treatment. Here, we present a rare case of concomitant bilateral occipital condyle fractures with an inferior clival avulsion fracture with concomitant focal injury of the tectorial membrane. Case Description: Following a motor vehicle accident, a 51-year-old female sustained multiple orthopedic and soft tissue injuries. The cervical computed tomography (CT) showed a bilateral occipital condyle avulsion fractures with an avulsion of the inferior clivus. The cervical magnetic resonance imaging additionally demonstrated focal injury to the tectorial membrane with edema of both atlanto-occipital joints. Although the patient was neurologically intact, the CCJ instability warranted an emergent occiput-C2 (O-C2) posterior instrumented arthrodesis using the modular (multiple piece) occipitocervical (OC) plates/rods. The surgery was uneventful, and the patient remained neurologically intact. The 3-month follow-up cervical X-ray demonstrated continued stability/bony fusion. Conclusion: Bilateral condyle fractures with a concomitant inferior clivus fracture are rare, and there is no known optimal strategy. Here, in an intact patient, instability of the CCJ warranted an O-C2 fusion.