Fibrous Nonunion of Odontoid Fractures: Is It Safe To Accept Nonoperative Management? A Systematic Review

Florman, Jeffrey E.; Gerstl, Jakob V. E.; Kilgallon, John L.; Riesenburger, Ron I.

doi:10.1016/j.wneu.2022.05.116

Cited by 10 publications

(7 citation statements)

References 25 publications

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Section: Resultsmentioning

confidence: 99%

“…28,29 A recent systematic review concluded that it is safe to forgo surgery for carefully selected patients with non-united odontoid fractures when near-anatomic alignment is present, dynamic instability is lacking on imaging studies, the neurologic examination findings are normal, and the risk of neck injury is low. 30 The complication rates in geriatric patients under 85 years of age treated operatively or conservatively do not differ in terms of frequency -but they do in terms of complication patterns. 26,31 The overall 90-day readmission rate after non-operative treatment is almost twice as high as after operative treatment.…”

Section: Treatmentmentioning

confidence: 99%

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Geriatric Odontoid Fractures: Treatment Algorithms of the German Society for Orthopaedics and Trauma Based on Expert Consensus and a Systematic Review

Osterhoff

Scholz²,

Disch

et al. 2023

Global Spine Journal

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Study Design Systematic review/expert consensus. Objectives Fractures of the axis represent the most frequent injury of the spine in elderly patients. Both, operative and non-operative treatment are associated with a high rate of complications and mortality. The aim of this article was to summarize the current literature on the management of odontoid fractures in geriatric patients and to weigh it based on an expert consensus process. Methods In a joint consensus process, members of the Spine Section of the German Orthopaedic and Trauma Society (DGOU) aimed to formulate recommendations for the diagnostic workup and treatment of odontoid fractures in geriatric patients. Based on the previously published recommendations, this article is an updated version with incorporating a systematic review of the recent literature. Results Based on the new data available, the recommendations established in the initial consensus process were adapted. Conclusions Computed tomography represents the diagnostic standard for patients with suspected injuries of the upper cervical spine. Anderson/D’Alonzo odontoid fractures type 1, non-displaced type 2, and type 3 can be treated conservatively. Even non-unions do not necessarily result in poor clinical outcome. In Anderson/D’Alonzo type 2 fractures, surgical therapy offers the advantage of relatively safe osseous healing with no increased complication rate even in elderly patients and can thus be recommended. In very high aged patients, however, a case-by-case decision should be made. When surgical stabilization of osteoporotic odontoid fractures is indicated, posterior techniques are biomechanically advantageous and can be considered the standard.

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Section: Resultsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Geriatric Odontoid Fractures: Treatment Algorithms of the German Society for Orthopaedics and Trauma Based on Expert Consensus and a Systematic Review

Osterhoff

Scholz²,

Disch

et al. 2023

Global Spine Journal

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“…23 Nonsurgical management of odontoid fractures might lead to solid fusion, unstable nonunion, or fibrous nonunion. 24 Fusion is influenced by patterns of damage, fracture subclass, the of a fracture line, angulation (more than or equal to 11 degrees), displacement (more or less than 5 mm), life support, bone quality, and the patient's and fracture's ages. 25 The benefits of employing HVI for odontoid fractures rather than surgery are that it offers stiff immobilisation and a high level of stability for atlantoaxial segments.…”

Section: Discussionmentioning

confidence: 99%

“…35 A conservative strategy may be justifiable for patients with excellent alignment, no dynamic instability, and no impairments. 24 For fracture types I and III in the majority of cases, halo fixation, cervical traction, and a stiff cervical collar result in the fusion of 100% of type 1 fractures, 90% of type III fractures, and 60% of type II fractures. 37 Biomechanically, a cervical collar is preferable to halo orthoses, while the risk of concomitant device-related problems is negligible.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Halo Vest Application for Type II and III Odontoid Fractures

Hashem,

Surur,

Hamad

2024

IJGM

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To assess halo vest applications for type II and III odontoid fractures and to ascertain the radiological and clinical outcomes of this approach. Methods: A cross-sectional retrospective study was conducted by reviewing the medical charts of selected patients having type II and III odontoid fractures who underwent halo vest treatment at the King Saud Medical City Orthopaedic Department. Radiographic evaluations for the cervical spine (anterior-posterior, lateral, and open-mouth views) were used. Computed tomography scans were used to delineate the extent of the fracture and to measure the magnitude of displacement, the degree of the angulation, the vertebrae involved, and the fracture type. Results: A total of 45 patients with odontoid fractures (55.6% of the patients with type II odontoid fractures and 44.4% of patients with type III) received halo vest treatment. In the present study, in type II odontoid fractures, union was achieved in 15.6% of patients, 28.9% of patients had malunion and 11.1% had nonunion. In type III odontoid fractures, union cases comprised 15.6% of patients, while malunion cases accounted for 28.9% of patients and nonunion cases were found in 4.4% of the patients. Conclusion:The halo vest management for type II and III odontoid fracture requires a prolonged course of cervical immobilisation. Multiple factors contribute to the alteration of the management protocol, patient adherence, and difficulties related to HV, and a significant rate of reduction loss ultimately results in malunion or nonunion.

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“…For all other axis fracture types, especially in adult horses, external copation does not achieve fracture stabilization . Although successful conservative treatment of displaced cranial mid-body axis fractures has been reported, conservative management carries a substantial risk of non-union and remains therefore controversial (Florman et al 2022). Fracture displacement, insufficient stabilization and comminution are amongst the main predisposing factors for non-union (Buckley and Richard 2018).…”

Section: Discussionmentioning

confidence: 99%

T-LCP Fixation of a cranial mid-body fracture of the axis in an adult horse

Schweitzer,

Croon,

Rossignol

2023

Preprint

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Cranial mid-body fractures of the axis in horses result from hyperflexion of the neck and are most commonly associated with lateral bending falls over showjumping or steeple chase fences. In the authors’ experience, conservative treatment of mild to moderately displaced cranial mid-body axis fractures has been unsuccessful. This case report describes surgical management of a cranial mid-body fracture of the axis in an eight-year-old warmblood gelding that sustained the injury during a showjumping course. Following reduction, a five hole 4.5mm equine compression T-plate was contoured to fit the ventral aspect of the axis and used as an internal fixator. The horse was turned out starting 2 months after surgery and training was gradually resumed. No lameness, ataxia or decrease in cervical range motion were reported after surgery. Check-up radiographs at 5 months post-op showed complete healing of the fracture. T-LCP fixation is a promising treatment option for cranial mid-body fractures of the axis with a good prognosis for athletic function.

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Fibrous Nonunion of Odontoid Fractures: Is It Safe To Accept Nonoperative Management? A Systematic Review

Cited by 10 publications

References 25 publications

Geriatric Odontoid Fractures: Treatment Algorithms of the German Society for Orthopaedics and Trauma Based on Expert Consensus and a Systematic Review

Geriatric Odontoid Fractures: Treatment Algorithms of the German Society for Orthopaedics and Trauma Based on Expert Consensus and a Systematic Review

Clinical and Radiological Outcomes of Halo Vest Application for Type II and III Odontoid Fractures

T-LCP Fixation of a cranial mid-body fracture of the axis in an adult horse

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