Functional Outcomes, Morbidity, Mortality, and Fracture Healing in 26 Consecutive Geriatric Odontoid Fracture Patients Treated With Posterior Fusion

Molinari, Robert W.; Dahl, Jason; Gruhn, William; Molinari, William J.

doi:10.1097/bsd.0b013e31823e99e4

Cited by 44 publications

(32 citation statements)

References 15 publications

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“…In the two studies applying the NDI, groups were evidently different; patients in one group had C50 % odontoid displacement and were treated surgically [26], those in the other group had B50 % odontoid displacement and were treated by external immobilization [27], still showing a slightly better outcome for surgically treated patients (18.1 and 15.7, respectively). This difference was, however, not clinically relevant.…”

Section: Outcome Compared Between Studiesmentioning

confidence: 97%

The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

2012

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Purpose Odontoid fractures are the most common cervical spine fractures in the elderly. As the population ages, their incidence is expected to increase progressively. The optimal treatment of this condition is still the subject of controversy. The objective of this review is to summarize and compare the outcome of surgical and conservative interventions in the elderly (C65 years). Methods A comprehensive search was conducted in nine databases of medical literature, supplemented by reference and citation tracking. Clinical status was considered the primary outcome. Fracture union and stability rates were considered secondary outcomes. Results A total of nineteen studies met the inclusion criteria. All studies were performed retrospectively and were of limited quality. There was insufficient data, especially from direct comparisons, to determine the difference in clinical outcome between surgical and conservative interventions. Osseous union was achieved in 66-85 % of surgically treated patients and in 28-44 % of conservatively treated patients. Fracture stability was achieved in 82-97 % of surgically patients and in 53-79 % of conservatively treated patients. Conclusions There was insufficient data to determine a potential difference in clinical outcome between different treatment groups. Surgically treated patients showed higher osseous union rates compared to conservatively treated patients, possibly because of different selection mechanisms. The majority of patients appears to achieve fracture stability regardless of the applied treatment. A prospective trial with appropriate sample size is needed to identify the optimal treatment of odontoid fractures in the elderly and predictors for the success of either one of the available treatments.

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Section: Outcome Compared Between Studiesmentioning

confidence: 97%

The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

2012

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“…14,15,19 However, surgical treatment of type II odontoid fractures in these often medically compromised patients is also associated with adverse outcomes and major complication rate. 20 For these reasons, the optimal management of elderly patients with type II odontoid fractures in isolation or combined remains controversial. 21,22 The association of C1 anterior arch with a C2 type II odontoid fracture is a rare combination, which to our knowledge has not been reported following nonoperative management.…”

Section: Discussionmentioning

confidence: 99%

Combined Type II Odontoid Fracture With Axis Anterior Arch Fracture

Malagelada

Tibrewal

Lucar

et al. 2014

Geriatr Orthop Surg Rehabil

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Associated fractures of the atlas and axis are frequent, particularly in the elderly patients following a simple low-energy fall. This injury can be easily misdiagnosed on initial plain radiographs, and therefore computed tomography scan is a useful adjunct in patients with a degenerative spine. There is still no consensus as to the optimal treatment of combined axis-atlas fractures, and the majority of authors propose a therapeutic strategy dependent on the odontoid fracture pattern. We describe a combined atlas and axis fracture in a 92-year-old patient who was managed with nonoperative treatment in a rigid collar. The association of C1 anterior arch with a C2 type II odontoid fracture is a rare combination, which to our knowledge has never been reported following nonoperative treatment. There was a good functional outcome at 1-year follow-up with the fracture progressing to a fibrous nonunion of the odontoid process.

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“…Le premier se situe vers 30 ans et l'autre vers 75 ans [34]. De plus, la catégorie « sujet âgé » est faite de deux sous-catégories, au-dessous ou au-delà de 74 ans, dont les caractéristiques sont diffé-rentes.…”

Section: Discussionunclassified

“…Par ailleurs, la durée moyenne d'immobilisation, par collier rigide ou halo corset, était souvent très prolongée pouvant atteindre 24 semaines [25,27,34]. Cette longue immobilisation et son retentissement sur l'autonomie peuvent paraître surprenants sur ce terrain de patients âgés.…”

Section: Discussionunclassified

“…Quatre études ont utilisé le score American Society of Anesthesiologists (ASA) [18,20,26,37], l'index de comorbidité de Charlson (CCI) [36] et le Cumulative Illness Rating Scale for Geriatrics (CIRS-G) [30]. Trois études renseignaient le nombre moyen de comorbidité par patient sans utiliser de score reconnu [21,34,38]. Les quatre études restantes détaillaient précisément les différentes comorbidités des patients [16,24,32,35].…”

Section: Caractéristiques Des éTudesunclassified

See 1 more Smart Citation

Complications des traumatismes du rachis cervical supérieur chez les sujets âgés. Revue systématique de la littérature

Jubert

Lonjon

Loubresse

et al. 2013

Revue de Chirurgie Orthopédique et Traumatologique

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Functional Outcomes, Morbidity, Mortality, and Fracture Healing in 26 Consecutive Geriatric Odontoid Fracture Patients Treated With Posterior Fusion

Cited by 44 publications

References 15 publications

The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

Combined Type II Odontoid Fracture With Axis Anterior Arch Fracture

Complications des traumatismes du rachis cervical supérieur chez les sujets âgés. Revue systématique de la littérature

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