Is the Use of a Cervical Collar Necessary in the Nonoperative Management of Type II Peg Fractures in the Elderly?

Leddy, Lauren; Temperley, Hugo; Gibbons, Denys; Ahern, Daniel P; Butler, Joseph S.

doi:10.1097/bsd.0000000000000821

Cited by 2 publications

(12 citation statements)

References 39 publications

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“…Our study population was mainly female, in keeping with the higher prevalence of osteoporosis in women and OF being a fragility fracture in patients over 65 years. 4 The 2 groups were comparable in comorbid status and frailty with the CCI and mFI-11 being similar in each group. Also, our results show that type II fractures were the most common and type I the least, again consistent with other studies.…”

Section: Discussionmentioning

confidence: 87%

“…2 Determining optimal treatment is therefore essential to allow timely decision making and reduce unnecessary morbidity and mortality. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

“…These characteristics make this group high risk when considering operative management and make decisions regarding the most appropriate treatment difficult. 4 Unfortunately, best non-operative management of odontoid fractures remains inconclusive within the literature. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

“… 4 Unfortunately, best non-operative management of odontoid fractures remains inconclusive within the literature. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

“…2 Determining optimal treatment is therefore essential to allow timely decision making and reduce unnecessary morbidity and mortality. 3,4 Fracture management in the elderly is a challenge due to reduced bone density, potentially poor general health and frailty. These characteristics make this group high risk when considering operative management and make decisions regarding the most appropriate treatment difficult.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Hard and Soft Cervical Collars for the Management of Odontoid Peg Fractures in the Elderly

Coleman

Chan

Gibbons

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction Odontoid peg fractures (OF) are the most common cervical spine fracture in the elderly. This retrospective analysis aimed to compare the outcomes of older patients with OF who had been managed non-operatively with either a hard or soft cervical collar. Materials and Methods We analysed the retrospective data of the clinical and radiographic records of patients 60 years or older who presented over a 10-year period with OF and were treated non-operatively with a cervical collar. Mortality was the primary outcome measure with mechanism of injury, complications, and fracture healing secondary measures. Results 45 patients (hard collar n = 22; soft collar n = 23) were included with comparable demographics for frailty and co-morbidities in each group; age was significantly higher in the soft collar group (80.6 vs 86.4 years; P = .0065). Associated injuries and complications were not significantly different overall, or when Type II fractures were separately analysed ( P = .435 associated injuries, P = .121 complications). All-cause mortality was greater in the soft collar group (30-day mortality hard: 0%, soft: 9%; 1-year mortality hard: 18%, soft: 48% P = .035). However, once corrected for age, this proved not to reach significance ( P = .333) in any fracture type. Non-union was common (77%) but was not significantly different (hard = 70%; soft = 87%; P = .419). Discussion Consistent with other reports, non-union rates remained substantial regardless of which collar was used. After controlling for age, there was no difference in all-cause mortality between elderly patients treated with a hard or soft cervical collar for odontoid peg fractures. Conclusions Soft collars appear suitable for the treatment of odontoid peg fractures in the elderly without compromising outcome. Larger cohort analyses will help confirm this finding.

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Section: Discussionmentioning

confidence: 87%

“…2 Determining optimal treatment is therefore essential to allow timely decision making and reduce unnecessary morbidity and mortality. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 4 Unfortunately, best non-operative management of odontoid fractures remains inconclusive within the literature. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of Hard and Soft Cervical Collars for the Management of Odontoid Peg Fractures in the Elderly

Coleman

Chan

Gibbons

et al. 2022

Geriatr Orthop Surg Rehabil

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Understanding the quality‐of‐life experiences of older or frail adults following a new dens fracture: Nonsurgical management in a hard collar versus early removal of collar

Closs,

Brennan,

Niven

et al. 2024

Health Expectations

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IntroductionIn the United Kingdom, fractures of the cervical dens process in older and/or frail patients are usually managed nonsurgically in a hard collar. However, hard collars can lead to complications and this management approach is now being questioned, with growing interest in maximising patients' short‐term quality‐of‐life. It is vital that patients' perspectives are considered; yet, there is a dearth of literature examining the aspect. To help inform wider decision‐making about use of collar/no collar management of dens fractures in older/frail people, we explored older/frail people's experience of the two management approaches and how they affected their perceived quality‐of‐life.MethodsWe interviewed older and/or frail adults with a recent dens fracture (aged ≥65 years or with a clinical frailty score of ≥5) or their caregiver. Participants were recruited from both arms of a clinical trial comparing management using a hard collar for 12 weeks (SM) with early removal of the collar (ERC) and were interviewed following randomisation and again, 12–16 weeks later. Data were analysed using a framework approach.ResultsBoth participant groups (SM/ERC) reported substantial, negative quality‐of‐life (QoL) experiences, with the fall itself and lack of access to care services and information being frequent major contributory factors. Many negative experiences cut across both participant groups, including pain, fatigue, diminished autonomy and reduced involvement in personally meaningful activities. However, we identified some subtle, yet discernible, ways in which using SM/ERC reinforced or alleviated (negative) QoL impacts, with the perceived benefits/burdens to using SM/ERC varying between different individuals.ConclusionStudy findings can be used to support informed decision‐making about SM/ERC management of dens fractures in older/frail patients.Patient or Public ContributionPublic and patient involvement contributors were involved in the study design, development of interview topic guides and interpretation of study findings.

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Is the Use of a Cervical Collar Necessary in the Nonoperative Management of Type II Peg Fractures in the Elderly?

Cited by 2 publications

References 39 publications

Comparison of Hard and Soft Cervical Collars for the Management of Odontoid Peg Fractures in the Elderly

Comparison of Hard and Soft Cervical Collars for the Management of Odontoid Peg Fractures in the Elderly

Understanding the quality‐of‐life experiences of older or frail adults following a new dens fracture: Nonsurgical management in a hard collar versus early removal of collar

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