Elderly patients are at increased risk for mortality undergoing surgical repair of dens fractures

BioMed Research International

Olerud

2014

Odontoid fractures type II according to Anderson and d'Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.

Section: Resultsmentioning

confidence: 99%

“…In 2013 four new retrospective cohort studies and one prospective study with altogether more than 400 cases were published on the treatment of odontoid fractures in the elderly [11–15]. It is therefore appropriate to revisit the published evidence on odontoid fracture treatment in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

BioMed Research International

Olerud

2014

“…The same trend has been shown in some earlier studies [ 12 , 27 , 28 ]. While several authors blame the ageing population for this development [ 12 , 29 ], the proportion of the elderly population did not increase in Uppsala and Malmö from 2002 to 2014. The reason for this specific population development is most likely the urban nature of the included municipalities and the migration of the younger population towards cities in Sweden [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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

Møller

BioMed Research International

et al. 2017

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.

“…A total of 1,468 studies were searched and screened. Finally, 12 articles ( 10 – 21 ) with a total of 452 patients (266 men and 186 women) were included in the study ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review

Bao¹,

Chen²,

Guo³

et al. 2023

Front. Surg.

BackgroundOdontoid fractures account for 15%–20% of cervical injuries. Although the operation methods vary in different types, the superiority of overall outcomes of the anterior approach (AA) and posterior approach (PA) in treating odontoid fractures still remains controversial. Thus, a meta-analysis was performed comparing AA and PA for these fractures.MethodsThe relevant studies were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, China Biological Medicine (CBM), and Wanfang Database from the onset of conception to June 2022. Prospective or retrospective comparative studies on AA and PA for odontoid fractures were screened, referring to fusion rates (primary outcomes), complications, and postoperative mortality rates. A meta-analysis of the primary outcomes and a systematic review of other outcomes were performed; the procedure was conducted with Review Manager 5.3.ResultsTwelve articles comrising 452 patients were included, and all publications were retrospective cohort studies. The average postoperative fusion rate was 77.5 ± 17.9% and 91.4 ± 13.5% in AA and PA, respectively, with statistical significance [OR = 0.42 (0.22, 0.80), P = 0.009]. Subgroup analysis showed a difference in fusion rates between AA and PA in the elderly group [OR = 0.16 (0.05, 0.49), P = 0.001]. Five articles referred to postoperative mortality, and the mortality rates of AA (5.0%) and PA (2.3%) showed no statistical difference (P = 0.148). Nine studies referred to complications, with a rate of 9.7%. The incidence of complications in AA and PA groups was comparable (P = 0.338), and the incidence of nonfusion and complications was irrelevant. The prevalent cause of death was myocardial infarction. The time and segmental movement retention of AA were possibly superior to those of PA.ConclusionAA may be superior in regard to operation time and motion retention. There was no difference in complications and mortality rates between the two approaches. The posterior approach would be preferred in consideration of the fusion rate.