Nonoperative Management of Dens Fracture Nonunion in Elderly Patients Without Myelopathy

Hart, Robert A.; Saterbak, Andrea; Rapp, Timothy; Clark, Charles R.

doi:10.1097/00007632-200006010-00004

Cited by 98 publications

(53 citation statements)

References 20 publications

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“…The clinical relevance of a dens nonunion in elderly patients is not yet clear. Some authors have advocated that a stable fibrous union can serve as a desirable end point 26,27 because of the paucity of literature describing adverse consequences of fibrous union in this population and the limited activity and lifespan of elderly patients with a dens fracture. In our experience, however, nonunion was frequently not well tolerated; thirteen (22%) of the fifty-eight patients treated nonsurgically crossed over to the surgical group because of symptomatic nonunion or late fracture displacement, suggesting that nonunion is not a desirable end point.…”

Section: Discussionmentioning

confidence: 99%

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Vaccaro¹,

Kepler²,

Kopjar³

et al. 2013

The Journal of Bone and Joint Surgery

121

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Section: Discussionmentioning

confidence: 99%

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Vaccaro¹,

Kepler²,

Kopjar³

et al. 2013

The Journal of Bone and Joint Surgery

121

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“…The presumed reasons for this trend include a reduction in functional reserve, a higher risk of airway compromise and urinary tract infections, and an increased risk of associated cardiac events in older people. This relationship is perhaps best demonstrated by the bimodal distribution of upper cervical injuries such as type-II odontoid fractures 10,12,25,27 . The bulk of published data addressing the prognosis after cervical fractures in elderly patients has consisted of comparisons of different treatment methods.…”

Section: Discussionmentioning

confidence: 99%

Mortality in Elderly Patients After Cervical Spine Fractures

Harris

Reichmann

Bono

et al. 2010

The Journal of Bone and Joint Surgery-American Volume

101

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“…Odontoid fractures comprise nearly 60% of all fractures of the axis and 10-18% of all cervical spine fractures [16,23]. Type II dens fractures again amount to approximately two-thirds of all odontoid fractures [14]. The high nonunion rate of conservatively treated type II fractures has been frequently reported and ranges from 26 to 47.5% depending on the clinical trail [6,11,13].…”

Section: Discussionmentioning

confidence: 99%

“…This high nonunion rate has been attributed to several causes. Factors potentially contributing to nonunion include the difficulty of maintaining an adequate reduction of the dens relative to the body of C2 [14]. Although the arterial blood supply to the dens is substantial for fracture healing, histologic sections of specimens retrieved from resections of odontoid nonunion do not show evidence of avascular necrosis [24].…”

Section: Discussionmentioning

confidence: 99%

Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases

et al. 2005

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IntroductionFractures of the odontoid process of the second cervical vertebra comprise 7-13 % of all cervical spine fractures [22]. Moreover, fractures of the axis' odontoid basis-classified as Anderson and D'Alonzo type II fractures-represent the most frequent type of dens fractures with about 66% [3,9,18]. Odontoid fractures occur at all ages with a bimodal distribution. In the younger group they are often secondary to high-energy trauma as motor vehicle accidents. The second peak in the incidence of odontoid fractures is in the elderly, where they appear as a result from low-energy injuries, such as falls from standing height [4,12,13,19]. Abstract During skeletal development the two ossification centers of the odontoid process are separated from the corpus of the axis by a subdental synchondrosis. This synchondrosis is thought to close and disappear spontaneously in adolescence although this has never been studied in detail. The basis of the dens is of clinical relevance as type II dens fractures are located here. To characterize the morphological architecture of the axis with particular attention to the subdental synchondrosis, the complete axis was harvested from thirty age-matched and gender-matched patients of the three different age groups at autopsy. The subdental synchondrosis and the bone structure of the dens, the basis of the dens and the body of C2 were analyzed by radiography, histology and quantitative histomorphometry. At the macroscopic level the persistency of the subdental synchondrosis in the adult cervical spine was detected in 87% (26 of 30) of the specimens. Histomorphometry revealed a residual disc blastema with an average size of 25.8% of the sagittal depth of the basis of the dens at this level. Bony integration of the synchondrosis was poor throughout all ages. Histologically a cartilaginous matrix composition of the subdental synchondrosis persisted throughout all groups. The trabecular microarchitecture demonstrated a significant reduction of bone volume and trabecular number as well as an increased trabecular separation within the basis of the dens as compared to the corpus or the dens of C2. This histomorphometric data regarding a poor integration of the synchondrosis into the trabecular network and the reduced bone mass within the basis of the dens might offer a previously underestimated explanation for the occurrence of type II dens fractures and their association with pseudoarthrosis, respectively. Matthias Gebauer

show abstract

Nonoperative Management of Dens Fracture Nonunion in Elderly Patients Without Myelopathy

Abstract: Although further follow-up evaluation is needed, the authors believe on the basis of this review that this treatment protocol may be considered for patients who are poor candidates for surgical fusion.

Cited by 98 publications

References 20 publications

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Mortality in Elderly Patients After Cervical Spine Fractures

Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases

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