The Tuli classification of occipital condyle fractures is a clinically-oriented system for describing these injuries based on fracture displacement and ligamentous injury. It is newer than the more well-known Anderson and Montesano classification of occipital condyle fractures and allows the incorporation of MRI findings.
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Classification
The classification is based upon fracture displacement and instability of the occipitoatlantoaxial (O-C1-C2) joint 1.
- type 1: undisplaced occipital condyle fracture
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type 2: displaced occipital condyle fracture
- type 2A: with stability of the O-C1-C2 joint
- type 2B: with instability of the O-C1-C2 joint based on any criteria from radiographic, CT, and/or MRI findings
The following criteria for O-C1-C2 instability were proposed:
- CT/radiographic criteria:
- >8 degrees of axial rotation of O-C1 to one side
- >1 mm of O-C1 translation
- >7 mm of overhang of C1 lateral masses on C2
- >45 degrees of axial rotation of C1-C2 to one side
- >4 mm of C1-C2 translation
- <13 mm distance between the posterior body of C2 to the posterior ring of C1
- avulsed transverse ligament
- MR evidence of ligamentous disruption
Epidemiology
The incidence distribution of the Tuli classification types amongst occipital condyle fractures has been reported 2,3:
- type 1: 56-58%
- type 2A: 23-34%
- type 2B: 11-19%
Treatment and prognosis
Tuli et al. suggested management according to the fracture type 1:
- type 1: no immobilization required
- type 2A: hard collar
- type 2B: halo vest or surgical fixation
History and etymology
The classification was proposed by Canadian neurosurgeon Sagun Tuli and colleagues in 1997 accompanying a case series of 3 patients diagnosed by CT and a literature review of 96 previously reported cases 1.
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