Predictors of mortality following conservatively managed fractures of the odontoid in elderly patients

Bajada, Stefan; Ved, A.; Dudhniwala, A.G.; Ahuja, Sashin

doi:10.1302/0301-620x.99b1.37989

Cited by 22 publications

(16 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The recommendation of surgery for all patients aged ≥50 years with OFx type II is a subject of debate, since most of these fractures occur in the elderly with major comorbidities and increased risks of surgical morbidity and mortality [16,19,20]. The bony fusion rate of OFx type II in patients aged ≥50 years is higher after surgical fixation than after external immobilization in a rigid collar or Halo-vest for 12 weeks [11,13,21].…”

Section: Introductionmentioning

confidence: 99%

Odontoid fractures: impact of age and comorbidities on surgical decision making

et al. 2020

View full text Add to dashboard Cite

Background Surgical fixation is recommended for type II and III odontoid fractures (OFx) with major translation of the odontoid fragment, regardless of the patient’s age, and for all type II OFx in patients aged ≥50 years. The level of compliance with this recommendation is unknown, and our hypothesis is that open surgical fixation is less frequently performed than recommended. We suspect that this discrepancy might be due to the older age and comorbidities among patients with OFx. Methods We present a prospective observational cohort study of all patients in the southeastern Norwegian population (3.0 million) diagnosed with a traumatic OFx in the period from 2015 to 2018. Results Three hundred thirty-six patients with an OFx were diagnosed, resulting in an overall incidence of 2.8/100000 persons/year. The median age of the patients was 80 years, and 45% were females. According to the Anderson and D’Alonzo classification, the OFx were type II in 199 patients (59%) and type III in 137 patients (41%). The primary fracture treatment was rigid collar alone in 79% of patients and open surgical fixation in 21%. In the multivariate analysis, the following parameters were significantly associated with surgery as the primary treatment: independent living, less serious comorbidities prior to the injury, type II OFx and major sagittal translation of the odontoid fragment. Conversion from external immobilization alone to subsequent open surgical fixation was performed in 10% of patients. Significant differences the in conversion rate were not observed between patients with type II and III fractures. The level of compliance with the treatment recommendations for OFx was low. The main deviation was the underuse of primary surgical fixation for type II OFx. The most common reasons listed for choosing primary external immobilization instead of primary surgical fixation were an older age and comorbidities. Conclusion Major comorbidities and an older age appear to be significant factors contributing to physicians’ decision to refrain from the surgical fixation of OFx. Hence, comorbidities and age should be considered for inclusion in the decision tree for the choice of treatment for OFx in future guidelines.

show abstract

Section: Introductionmentioning

confidence: 99%

Odontoid fractures: impact of age and comorbidities on surgical decision making

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Proportional survival differences according to treatment were tested with the chi-squared test. Using the Cox proportional hazards regression method, the contribution of multiple covariates to survival was analyzed and presented as hazard ratio (HR) with 95% CI and probability p. Besides surgical treatment, age, gender [23], spinal cord injury [24,25], and CCI score [26] were identified as relevant covariates for survival. Because we assumed that medical advancement had improved patient survival in general in recent decades, every year of admission was included as a covariate in the model.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, in the present study, we compared the cohort of all odontoid type 3 fractures and non-surgically treated type 2 fractures with the cohort of surgically treated odontoid type 2 fractures. A recent study has identified odontoid type 3 fractures as a predictor of 1-year mortality [25]. Unfortunately, the detail in ICD-10: S12.1 does not allow us to adjust for C2 fracture subtypes.…”

Section: Strengths and Weaknesses Of This Studymentioning

confidence: 99%

Surgical treatment improves survival of elderly with axis fracture—a national population-based multiregistry cohort study

2018

View full text Add to dashboard Cite

show abstract

“…Odontoid fractures constitute the commonest cervical spinal fracture in the elderly population [ 1 ]. Early mobilization is essential to prevent clinical deterioration from medical comorbidities or other illnesses due to prolonged recumbence with reported 16% 30-day mortality rate [ 2 ]. This has led to a more aggressive posture towards surgical stabilization of unstable type II fractures according to the Anderson and D’Alonzo classification and may be achieved by either an anterior or posterior approach [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment of type II odontoid fracture in the elderly

Hamilton

Lawrence

Eisenring

2020

Journal of Surgical Case Reports

View full text Add to dashboard Cite

Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

show abstract

Predictors of mortality following conservatively managed fractures of the odontoid in elderly patients

Abstract: We suggest that these easily identifiable predictors present on admission can be used to identify patients at high risk and guide management by a multidisciplinary team. Cite this article: Bone Joint J 2017;99-B:116-21.

Cited by 22 publications

References 32 publications

Odontoid fractures: impact of age and comorbidities on surgical decision making

Odontoid fractures: impact of age and comorbidities on surgical decision making

Surgical treatment improves survival of elderly with axis fracture—a national population-based multiregistry cohort study

Treatment of type II odontoid fracture in the elderly

Contact Info

Product

Resources

About