Transverse Clival Fracture With Vertical Displacement: A Case Report Publisher



Fattahi A¹ ; Taheri M¹ ; Koohestani H² ; Ravansalar M² ; Shahhoseini A²
Source: Trauma Monthly Published:2022

Abstract

Clival fracture is a rare traumatic injury that usually occurs in patients suffering high-energy trauma to the head and neck. Here, we present and discuss our experience in a patient with a transverse clival fracture associated with significant vertical displacement. A 52-year-old comatose patient was admitted to our emergency department after a high-energy motor vehicle accident. The physical examination revealed a Glasgow Coma Scale (GCS) of 6 (with a motor scale of 4) associated with a left-sided six cranial nerve palsy, a left-sided fixed and dilated pupil; and quadriparesis that was more severe on the right side. The imaging tests revealed brain contusions, pneumocephalus, and generalized brain edema without local mass effect or midline shift. Also, it showed TCF with significant vertical displacement and a signal change within the medulla oblongata. The clival fracture was managed using a mild head flexion position without bracing, and a routine ICU exchange body positioning program. The follow-up imaging three months later showed complete bone fusion without any displacement. After 18 months, he was ambulated, and cranial nerve deficit improved except for mild diplopia due to a remnant 6 cranial nerve paresis. Transverse clival fracture, as most of the authors report, does not need surgical treatment. Bracing can be used in conscious ambulatory patients. A mild head-on-neck flexion position associated with supporative care for bedsores must be done for unconscious patients. © 2022 Kowsar Medical Publishing Company. All rights reserved.