Odontoid fractures in elderly patients

Abstract

This retrospective analysis describes the clinical characteristics, treatment, and outcome of 19 patients aged 80 years or older with odontoid fractures. The fractures were due to falls in 15 patients (78.9%) and were associated with motor-vehicle accidents in four. Type III fractures were seen in three patients and type II fractures in 16. No patient suffered a neurological injury associated with the fracture. Five patients (26.3%) died during hospitalization; factors contributing to their death included prolonged bed rest, associated injuries, and concomitant medical illnesses. The mean follow-up period in the remaining 14 patients was 28.8 months (range 5 to 72 months). Eight patients with a posterior displacement of 5 mm or less were treated with cervical immobilization, three of whom showed a stable non-union of the fracture site at follow-up review. One patient with 10-mm displacement refused operative treatment. Three of the patients without surgical treatment subsequently died from unrelated causes; all remaining patients resumed their routine activity. Five patients with displacement of 5 mm or greater and instability at the fracture site were treated with posterior cervical fusion of C1-2 using wire and autologous iliac bone grafts. In this group, no operative morbidity or mortality occurred and stable constructs developed in all patients; one patient died from an unrelated cause during the follow-up period and the other patients resumed their normal activity. Prolonged bed rest caused respiratory complications in two of six patients who survived initial hospitalization; two of three patients treated with rigid immobilization developed complications that required alternative treatments.

Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

“…In contrast to previous studies dealing with this clinically relevant topic [1,6,9,10,15,31,64], all patients included in this study were subject to not only pre-but also postoperative CT-scans, providing valuable data regarding fracture properties and factors influencing osseous union rates. Our findings confirmed that AOSF in the recent reducible OF represents a safe alternative to posterior fusion in the appropriately selected elderly patient and fracture.…”

“…The impact of patients' age at index surgery on outcome was discussed controversially. While it was shown to have significant impact on union rates in several studies [6][7][8][9][10]30], other authors did not find a significant correlation between age and union rates [15,18,20,31]. Besides age, the number of screws used for AOSF might have significant impact on union rates, too.…”

“…Previous studies served evidence for increased risk of pseudoarthrosis with OF treatment in the elderly [6][7][8][9][10][11] correlating with the different techniques available and their related morbidity [12]. Accordingly, the decision making process regarding the ideal method remains challenging.…”

“…Notably, assessment of union in previous outcome studies on AOSF in the elderly [6][7][8][9][10][11]28] was based on radiographs only, while a recently published study demonstrated that reliability of OF union assessment is moderate using radiographs only if compared to CT scans as the standard of reference [35].…”

The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

“…There is no single universally accepted method of management of these fractures [11,25]. Nonoperative treatment with a rigid brace can result in fracture healing without need for surgery [5], but a mortality rate of 26% to 47% in elderly patients has been reported, perhaps as a result of respiratory-related complications due to prolonged external immobilization [7,23,31,35]. Reported healing after external immobilization has varied widely from 7% to 100% [26][27][28].…”