C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases

Abstract

The currently available data on the distribution of C2 fracture subtypes is sparse. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. A dataset of all patients treated between 2002 and 2014 for C2 fractures was extracted from the regional hospital information system. C2 fractures were classified into odontoid fractures types 1, 2, and 3, Hangman's fractures types 1, 2, and 3, and atypical C2 fractures. 233 patients (female 51%, age 72 ± 19 years) were treated for a C2 fracture. Odontoid fractures were found in 183 patients, of which 2 were type 1, 127 type 2, and 54 type 3, while 26 of C2 fractures were Hangman's fractures and 24 were atypical C2 fractures. In the geriatric subgroup 89% of all C2 fractures were odontoid, of which 71% were type 2 and 29% type 3. There was an increasing incidence of odontoid fractures types 2 and 3 from 2002 to 2014. 40% of C2 fractures were treated surgically. This study presents reliable subset proportions of C2 fractures in a prospectively collected regional cohort. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures.

Geriatrische Dens-Fraktur – Konservative Therapie

“…Die Empfehlungen zur Therapie der weitaus häufigsten Typ-II-Fraktur sind jedoch, insbesondere bezogen auf die Densfraktur Typ II des alten Menschen, nach wie vor kontrovers [1, 3, 8 -10]. Dies ist wichtig, da mit steigendem Alter nicht nur die Anzahl der Densfrakturen an sich, sondern auch die Rate an Typ-II-Frakturen im Vergleich zu Typ I und Typ III ansteigt [5,10].…”

“…▪ Komorbiditäten nehmen mit dem Alter zu, beeinflussen die Morbidität und Mortalität und können Auswirkungen auf das Heilungspotential haben [8,12,15]. ▪ Die Mortalitätsrate bei diesen Frakturen ist generell hoch, unabhängig von der gewählten Therapie [5,11,12]. ▪ Das perioperative Risiko sowie das Komplikationsrisiko nach längeren Immobilisationen steigen mit zunehmendem Alter und mit der Zunahme der Komorbiditäten [10,13,14].…”

“…Diese Daten resultieren überwiegend aus Metaanalysen und Reviews, welche die zur Verfügung stehenden Daten, basierend auf retrospektiven Fallserien, zusammenfassen. In der Mehrzahl der Fälle wurden dabei keine CTʼs, sondern Röntgendaten ausgewertet, auch sind die Nachuntersuchungszeiträume unterschiedlich gewählt worden [5,10].…”

The Anterior Transarticular Fixation of C1/C2 in the Elderly With Dens Fractures

“…9 Consequently, this leads to a rising number of patients with fractures of the cervical spine, especially C2 fractures. 10 In general, these elderly patients carry more comorbidities that in turn may increase the perioperative risk of a surgical intervention. Not surprisingly, a high morbidity and mortality rate associated with the surgical treatment of odontoid fractures, especially in elderly patients, has been published.…”

Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients

“…C2 fractures can be roughly divided into three categories [1]: fractures of the dens (the most common), hangman's fracture involving both pedicles, and atypical fractures (e.g., involving the vertebral body, unilateral, or complex). Hangman's fracture (or bilateral pars interarticularis fracture of C2) is caused by either hyperextension and distraction or hyperextension and compression.…”