Nonoperative Management of Type II Odontoid Fractures in the Elderly

Koech, F; Ackland, Helen M; Varma, Dinesh; Williamson, Owen Douglas; Malham, Gregory M.

doi:10.1097/brs.0b013e31818d5407

Cited by 86 publications

(78 citation statements)

References 38 publications

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“…In concordance with the literature, union rate in non-op patients was 58% [36,42]. Non-operative management has been the treatment of choice for many years [41] and often results in fracture stability, by either osseous union or fibrous union in almost all patients [26]. Thus stable fibrous union may be an acceptable aim in the elderly patient [16,26].…”

Section: Discussionsupporting

confidence: 64%

“…Non-operative management has been the treatment of choice for many years [41] and often results in fracture stability, by either osseous union or fibrous union in almost all patients [26]. Thus stable fibrous union may be an acceptable aim in the elderly patient [16,26]. The long-term outcome of stable non-unions remains unknown or might not even matter at all in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Minerva plaster cast treatment [7] for unstable odontoid fractures was not considered a treatment option anymore in contrast to the treatment portfolio at the same institution in the mid-1990s [27]. Some authors consider halo thoracic bracing is preferable to cervical collars [26] while others have abandoned this Halo vest treatment [43], or found them poorly tolerated by the patients older than 75 years of age [36] with a questionable efficacy to prevent in vivo motion [3]. Similar to Polin and coworkers we favored the use of the rigid cervical orthosis in the majority of cases [39], given the lack of significant difference in the need for late surgical procedures and improved patient comfort with cervical orthosis and elimination of the risk of halo-related complications.…”

Section: Discussionmentioning

confidence: 99%

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Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

et al. 2011

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Introduction Type II odontoid fractures are one among the most common cervical spine fractures in the elders. We reviewed a consecutive series of patients, aged 65 years and older, presenting to our institution with type II odontoid fractures. Our analysis focused on the radiographic outcome, union rate and the development of cervical spine postural deformity. Patients/methods Indications for surgical treatment (OP) included displaced or unstable injuries. Stable, nondisplaced injuries or patients with significant co-morbidities were treated nonoperatively (non-op). Results Ninety patients (50 f, 40 m) with an average age of 83 years (65-101) were identified. 31 (34.4%) patients were received OP and 57 (63.3%) were received non-op treatments. The hospital length of stay was significantly longer after OP (mean 10 days vs. 6 days non-op) treatment (p = 0.007). At follow-up, higher union rates were noted in the OP (76.2%) than in the non-op group (58.3%). Conclusion We observed a characteristic cervical spine deformity in geriatric patients with type II odontoid fractures, and have termed this the ''Geier-deformity''. Clinical findings of the deformity include sagittal imbalance and kyphosis of the lower cervical spine.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

et al. 2011

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“…In this study, the morbidity rate was 62% without distinction between surgical procedures. The other studies did not distinguish octogenarians from other elderly patients [3,5,7,8,11,13,15,18,24,25]. We specifically studied type IIB OF because among all types of OF they are considered as the most unstable.…”

Section: Discussionmentioning

confidence: 99%

“…Several management options are described in the literature: rigid and non-rigid immobilisations, anterior screw fixation of the odontoid and posterior fusion of the C1/C2 complex [19]. Authors advocating surgical treatment criticize the morbidity associated with prolonged cervical immobilisation [15] whereas authors advocating orthopaedic treatment invoke the risks of surgical intervention [2,11]. The initial surgical treatment by posterior fusion of the C1/C2 complex provides the highest fusion rates [2,8].…”

Section: Introductionmentioning

confidence: 99%

Anterior screw fixation of type IIB odontoid fractures in octogenarians

et al. 2011

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Purpose Type IIB odontoid fractures (OF) in elderly patients are life-threatening conditions. Optimal treatment of these fractures is still controversial. The aim of this study was to assess the clinical and radiological outcome of surgically treated type IIB OF by anterior screw fixation in octogenarians. Methods Eleven octogenarians with type IIB OF were operated using anterior screw fixation. Follow-up assessment included operative mortality and morbidity rates, long-term functional outcome and fracture union and stability. Results There was neither operative mortality nor morbidity. Five patients had excellent clinical outcome, two good outcome, one fair and three poor. Two patients died of unrelated causes 2 months after surgery. Radiographs showed stable bone union in four patients and stable fibrous union in five patients. Conclusions Given the results in this short series, we suggest that anterior screw fixation of Type IIB OF may be offered as primary treatment in octogenarians.

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