IntroductionThe appropriate treatment of type II and III odontoid fractures still remains controversial. However in the recent literature there seems to be a tendency to opt for primary internal fixation with interfragmentary screws [1,7,8,19,23,29,36]. The reported rate of non-union varies between 2.4% and 100% for all types of fractures and treatment modalities, with the highest rates for untreated fractures and fractures treated with a cervical collar only. Important factors reported to contribute to non-union of these fracAbstract Despite various reports on the management of odontoid fractures, there is no consensus on the subject, and the appropriate treatment still remains controversial. While untreated fractures or fractures treated only with a cervical orthosis seem to have the highest rate of nonunion, the need for rigid external stabilisation has never been substantiated. In a retrospective analysis we reviewed 26 patients with acute type II and III fractures of the odontoid, treated with a cervical orthosis only. Study inclusion was limited to fractures that had a fracture gap of less than 2 mm, an initial antero-posterior displacement of less than 5 mm and angulation of less than 11°, less than 2 mm displacement on lateral flexion/extension views, and were without neurological deficits. These fractures were defined as stable. There were 19 (73.1%) type II and 7 (26.9%) type III fractures; in 10 (38.5%) of these fractures the odontoid was displaced and/or angulated. The overall complication rate was 11.4% (n=3). One patient suffered from pulmonary embolism, in two patients (7.7%) with initially minimally displaced fractures, secondary internal stabilisation had to be performed because of persistent instability. In 20 (77%) of the remaining fractures healing was uneventful. In 4 nondisplaced fractures (15%) fibrous union was documented. Three of these patients were over 65 years old. The overall fusion rate was 73.7% for type II and 85.7% for type III fractures. At follow-up 39% of the patients were free of symptoms; however, the clinical outcome did not correlate with the radiological findings. According to our findings, stable type II and type III fractures of the odontoid can be successfully treated with non-rigid immobilisation, even if they are displaced. A thorough assessment of the stability of the odontoid with lateral flexion/extension views or dynamic fluoroscopy is recommended to evaluate the appropriate treatment. Nonrigid immobilisation may be an option in selected cases with stable injuries.

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This article aims at determining the differences in resources needed for the treatment of patients with rheumatoid arthritis as opposed to osteoarthritis. Data on ten patients for each of these diagnoses, all of whom had been subject to the implantation of a knee arthroplasty,were compared. We looked at parameters such as the duration of surgery, further diagnoses, costs of radiological measures and medical treatment, simultaneous operations, need of nursing care,physical and occupational therapy and complications. Patients presenting with rheumatoid arthritis in many respects required substantially more clinical and/or financial resources than osteoarthritis patients. This statement holds true at least for the period of hospital care during which the knee-prosthesis was implanted.

The aim of this study was to compare total hip replacement (THR) in rheumatoid and osteoarthritic patients. Ten rheumatoid and ten osteoarthritic patients undergoing THR were compared with respect to preoperative diagnostics, operative therapy, nursing and rehabilitation. Statistically significant differences existed between the groups: In rheumatoid patients, radiographic diagnostics were more extensive ( P=0.0021), surgery time was extended ( P=0.0355), referrals to non-orthopedic subspecialties were more frequent ( P=0.0524) and rehabilitation was more extensive ( P=0.0000). The groups were not significantly different with respect to the duration of hospitalisation, preoperative hemoglobin, perioperative blood loss, transfusion requirements, duration of intensive care and nursing requirements. THR in the rheumatoid population required additional resources during inpatient therapy in comparison to THR in osteoarthritic patients.