Immobilisation in occipital condyle fractures: A systematic review

•Occipital Condyle Fractures are under-diagnosed and have important clinical and anatomical considerations.•21/25 studies had an Oxford Centre for Evidence Based Medicine Score of 4.•Overall, current management recommendations is based on Level III evidence•Randomised controlled trials are needed to determine optimal management The objectives of this review are to determine the level of evidence for the management of OCF, compare outcomes of different immobilisation, and to review the prognosis. A literature search was conducted using 3 databases (MEDLINE, PubMed and EMBASE). All papers between 1940 and July 2017 were screened using PRISMA guidelines. Inclusion criteria were patients with a confirmed diagnosis of occipital condyle fracture(s) on CT managed with any form of immobilisation with no age restriction. Primary outcome was clinical improvement in symptoms or Neck Disability Index. MINORS and OCEBM level was assigned to each study. 25 studies met the inclusion criteria. Most studies used a single form of C-spine immobilisation support (58%) with a semi rigid collar and halo device being the most common. From these studies, the average length of time for immobilisation was 11.7 weeks, 9 weeks and 8.3 weeks for halo, semi-rigid and rigid cervical collars respectively. Neuro deficit was found in 20.3% of patients. OCEBM level of evidence and MINORS score was low. Management of OCF is associated with low level of evidence. Further studies are needed to determine optimal management of these under-diagnosed fractures.