Surgical Treatment of Dens Fractures in Elderly Patients

Platzer, Patrick; Thalhammer, Gerhild; Oberleitner, Gerhard; Schuster, Rupert; Vécsei, V.; Gaebler, Christian

doi:10.2106/jbjs.f.00968

Cited by 64 publications

(41 citation statements)

References 20 publications

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“…A complete recovery of neurologic function was seen after rehabilitation in four patients, whereas incomplete deficit resolution was noted in [12,20]. Perioperative and postoperative complication rates ranged from 6.2% [15] to 33.9% [32] and classified as local and general [33] (Table 3).…”

Section: Resultsmentioning

confidence: 98%

“…The mean methodology score of 37.1 (range, 21.0 [19] to 55.0 [32,33]) suggested an overall low methodologic quality. The association between the methodology score and year of publication (r = 0.44, p = 0.037) demonstrated the quality of methods has improved over the decades, particularly in the last 5 years.…”

Section: Resultsmentioning

confidence: 99%

“…Three of the 16 studies [1,12,32] noted assessment of cervical ROM but none reported numerical data.…”

Section: Resultsmentioning

confidence: 99%

“…One study [32] reported return to preinjury activity level after surgery: postoperatively, 45 of 48 patients (93%) returned to preinjury activity. No study investigated the ability to participate in sports after surgery.…”

Section: Resultsmentioning

confidence: 99%

“…According to available imaging data, the mean preoperative displacement ranged from 3.8 mm (range, 0-8 mm) [32] to 8.66 mm (range, 6-10 mm) [11]. Three hundred ninety-three of 475 (82.7%) radiographically assessed patients showed postoperative bone healing, with bone union rates ranging from 33% [30] to 100% [10][11][12]20] (Table 3) and increased union rates in patients operated on within 6 months of injury [5].…”

Section: Resultsmentioning

confidence: 99%

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The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

Denaro

Papalia

Martino

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Odontoid fractures are the most common odontoid injury and often cause atlantoaxial instability. Reports on postoperative status of patients who underwent surgery for such injuries are limited to small case series, and it is unclear whether any one technique produces better outcomes than another. Questions/purposes We assessed the quality of the available literature for management of Type II odontoid fractures and surgery-related parameters, including surgical indications, clinical failure rate, and survivorship, postoperative ROM and function, neurologic deficits, complication and death rates, and radiographic healing rates related to either anterior dens screw or posterior C1-C2 fusion.Methods We performed a systematic search in PubMed, Ovid, Cochrane Reviews, and Google Scholar databases. We used the methodology score proposed by Coleman et al. to rate study quality. Postoperative imaging bone union rates were extracted. Postoperative complications and neurologic impairment data were also collected. Results Sixteen retrospective studies of overall low quality (average methodology score, 37.1) reporting a total of 518 patients were included. The methodology score and publication year were positively associated. The bone union rate approximated 83% (range, 33%-100%), with higher nonunion rates among patients older than 65 years. The death rate ranged widely (0%-28.6%) among different centers. Residual cervical pain was documented postoperatively from 10.5% to 26.7%, while survivorship ranged from 72% to 96.6%. No ROM data were reported. Conclusions Current data on patients who had surgery for fracture of the dens did not allow us to establish superiority of one surgical approach over another.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

“…Three of the 16 studies [1,12,32] noted assessment of cervical ROM but none reported numerical data.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

Denaro

Papalia

Martino

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly

Kaesmacher

Schweizer

Valentinitsch

et al. 2017

Journal of Bone and Mineral Research

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Traumatic odontoid fractures (TOFs) have been described as the most common injury affecting the C-spine in the elderly. Previous studies have identified degenerative changes and bone loss as important predisposing factors. However, their interaction and respective age-adjusted impact needs further clarification. We conducted a retrospective analysis of 5303 patients (aged ≥60 years) admitted to a level I trauma center between January 2008 and January 2016 who underwent CT imaging of the C-spine. Ninety-two patients with TOF and 80 patients with other cervical spine fractures (OCSF) were identified and a respective 3:1 age- and sex-matched control group without fractures after trauma was built. In all groups, cervical bone mineral density (cBMD) was determined using phantom calibration, and degenerative changes were evaluated in a qualitative manner. In all groups, the severity of degenerative changes of the C-spine increased with age (all p < 0.05) and was inversely correlated with cBMD (all p < 0.05). cBMD was the only significant predictor of a TOF in a multivariate logistic regression model (adjusted odds ratio [OR] = 3.066, 95% confidence interval [CI] 1.432-6.563 for cervical osteoporosis). An association between odontoid cysts and TOF reached significance only in Anderson and D'Alonzo (A&D) type II TOFs (aOR = 1.383; 95% CI 1.012-1.890). Patients with OCSFs, compared with patients with TOFs, were younger (median 74 versus 83 years) and had a higher cBMD (median 208 mg/mL versus 172 mg/mL). No differences were observable when comparing cBMD and grades of degenerative changes between OCSFs and their control group (all p >0.1). Decreased cBMD is the major predisposing factor for the occurrence of TOF but not for OCSF in the elderly. The severity of odontoid cysts was found to be a cBMD-independent factor associated with A&D type II TOFs. However, degenerative changes in the odontoid neighboring joints seem to be an epiphenomenon of bone loss and older age but do not independently predispose for TOF. © 2017 American Society for Bone and Mineral Research.

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