Therapiekonzept und Outcome bei Typ-II-Frakturen des Dens axis

Meyer, Carolin; Oppermann, Johannes; Meermeyer, Ingo; Eysel, Peer; Müller, Lars Peter; Stein, Gregor

doi:10.1007/s00113-017-0428-9

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…Crockard et al report mortality rates between 25% and 40% in case of a fracture of the Dens [16]. For the general practitioners is important the age distribution of the dens fractures -two peaks are proven -high-energy traumas in young patients and low-energy injuries in elderly patients [17]. In our clinical study, the leading mechanism of injury was motor vehicle accidents -30.6%.…”

Section: Discussionmentioning

confidence: 55%

Clinical Behavior of General Practitioners for Patients who Underwent an Operative or Conservative Treatment for a Craniocervical Fracture

Kalnev

Uchikov

Kehayov

2022

Open Access Maced J Med Sci

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Craniocervical fractures are socially important pathology. They represent one-third of the fractures in the cervical region. It is typical that elderly patients suffer from low-energy traumas such as falls, while younger patients suffer from high-energy traumas such as motor vehicle accidents, sport falls and etc. Craniocervical fractures are associated with an increased risk of craniocervical instability or neurological deficit. Primary therapeutic options depend on the type of fracture. Predictors of nonunions are the displacement of fractures, patients’ age, and comorbidities. The observership of the general practitioner in the postoperative period or the period of cervical immobilization could recognize possible malpositioning of the instrumentation, nonunion of the fracture, malsanation of the wound, and possible complications in case of the external immobilization. There is a lack of information on that topic. The goal of the paper is to summarise the most common fractures of the craniocervical region, their etiology, and treatment options and to present the results of our study of patients who underwent operative treatment for craniocervical fracture(s). Mastering the details, the treatment options, and the possible complication of the fractures in the craniocervical region, general practitioners could play an important role in the treatment of patients.

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Section: Discussionmentioning

confidence: 55%

Clinical Behavior of General Practitioners for Patients who Underwent an Operative or Conservative Treatment for a Craniocervical Fracture

Kalnev

Uchikov

Kehayov

2022

Open Access Maced J Med Sci

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“…Anterior screw fixation with one or two screws allows full rotational movement in the segment C1/C2. Although, in Eysel/Roosen type C fractures the risk for secondary loss of reduction is very high due to screw loosening in the corpus of C2 subsequently requiring revision surgery 18,23,30. Nonunion is one of the most important indications for revision surgery after odontoid fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Although, in Eysel/ Roosen type C fractures the risk for secondary loss of reduction is very high due to screw loosening in the corpus of C2 subsequently requiring revision surgery. 18,23,30 Nonunion is one of the most important indications for revision surgery after odontoid fractures. Revision surgery is associated with an increased risk for complications and perioperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

A Predictive Model to Identify Treatment-related Risk Factors for Odontoid Fracture Nonunion Using Machine Learning

Leister

Haider

Vogel

et al. 2022

Spine

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Study Design. Multicenter retrospective analysis of routinely collected data. Objective. The underlying aim of this study was to identify potential treatment-related risk factors for odontoid fracture nonunion while accounting for known patient- and injury-related risk factors. Summary of Background Data. Type II and III odontoid fractures represent the most common cervical spine fracture in elderly patients and are associated with a relatively high nonunion rate. The management of odontoid fractures is controversial and treatment strategies range from conservative treatment to extensive surgical stabilization and fusion. Methods. A total of 415 individuals who sustained odontoid fracture and were treated in either of four tertiary referral centers in Austria and Germany were included in the study. We included the following potential contributing factors for fracture nonunion in cross-validated extreme gradient boosted (XGBoost) and binary logistic regression models: age, gender, fracture displacement, mechanism of injury (high vs. low energy), fracture classification (Anderson II vs. III), presence of comorbidities (Charlson comorbidity index), and treatment (conservative, anterior screw fixation with one or two screws, posterior C1/C2 spondylodesis, cervico-occipital C0–C4 fusion). Results. In our cohort, 187 (45%) had radiologically confirmed odontoid nonunion six months postinjury. The odds for nonunion increase significantly with age, and are lower in type III compared to type II fractures. Also, odds for nonunion are significantly lower in posterior C1/C2 spondylodesis, and C0–C4 fusion compared to conservative treatment. Importantly, odds are not statistically significantly lower in the group treated with anterior screw fixation compared to conservative treatment. The factors gender, fracture displacement, mechanism of injury, and the presence of comorbidities did not produce significant odds. Conclusion. Higher age, type II fractures, and conservative treatment are the main risk factors for odontoid nonunion. Anterior screw fixation did not differ significantly from conservative treatment in terms of fracture union. Level of Evidence. 3.

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“…All 22 studies were observational cohort analyses (20 retrospective, 2 prospective). 1,4,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] A total of 963 patients undergoing surgical stabilization (ADS 527, PA 436) of their odontoid fracture were included in this systematic review and meta-analysis. Based on studies with available data, the majority of the odontoid fractures were type II, with only 86 fractures being reported as type III based on the Anderson-D'Alonzo classification.…”

Section: Literature Search and Characteristics Of The Included Studiesmentioning

confidence: 99%

Outcomes following anterior odontoid screw versus posterior arthrodesis for odontoid fractures: a systematic review and meta-analysis

Texakalidis

Matsoukas

Karras

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE Odontoid fractures can be managed surgically when indicated. The most common approaches are anterior dens screw (ADS) fixation and posterior C1–C2 arthrodesis (PA). Each approach has theoretical advantages, but the optimal surgical approach remains controversial. The goal in this study was to systematically review the literature and synthesize outcomes including fusion rates, technical failures, reoperation, and 30-day mortality associated with ADS versus PA for odontoid fractures. METHODS A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching the PubMed, EMBASE, and Cochrane databases. A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity. RESULTS In total, 22 studies comprising 963 patients (ADS 527, PA 436) were included. The average age of the patients ranged from 28 to 81.2 years across the included studies. The majority of the odontoid fractures were type II based on the Anderson-D’Alonzo classification. The ADS group was associated with statistically significantly lower odds to achieve bony fusion at last follow-up compared to the PA group (ADS 84.1%; PA 92.3%; OR 0.46; 95% CI 0.23–0.91; I2 42.6%). The ADS group was associated with statistically significantly higher odds of reoperation compared to the PA group (ADS 12.4%; PA 5.2%; OR 2.56; 95% CI 1.50–4.35; I2 0%). The rates of technical failure (ADS 2.3%; PA 1.1%; OR 1.11; 95% CI 0.52–2.37; I2 0%) and all-cause mortality (ADS 6%; PA 4.8%; OR 1.35; 95% CI 0.67–2.74; I2 0%) were similar between the two groups. In the subgroup analysis of patients > 60 years old, the ADS was associated with statistically significantly lower odds of fusion compared to the PA group (ADS 72.4%; PA 89.9%; OR 0.24; 95% CI 0.06–0.91; I2 58.7%). CONCLUSIONS ADS fixation is associated with statistically significantly lower odds of fusion at last follow-up and higher odds of reoperation compared to PA. No differences were identified in the rates of technical failure and all-cause mortality. Patients receiving ADS fixation at > 60 years old had significantly higher and lower odds of reoperation and fusion, respectively, compared to the PA group. PA is preferred to ADS fixation for odontoid fractures, with a stronger effect size for patients > 60 years old.

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Therapiekonzept und Outcome bei Typ-II-Frakturen des Dens axis

Abstract: The simple clinical applicability together with the low rate of non-union development shows that the Eysel and Roosen classification appears to be a suitable guide for clinical use when deciding on the appropriate treatment regimen.

Cited by 7 publications

References 27 publications

Clinical Behavior of General Practitioners for Patients who Underwent an Operative or Conservative Treatment for a Craniocervical Fracture

Clinical Behavior of General Practitioners for Patients who Underwent an Operative or Conservative Treatment for a Craniocervical Fracture

A Predictive Model to Identify Treatment-related Risk Factors for Odontoid Fracture Nonunion Using Machine Learning

Outcomes following anterior odontoid screw versus posterior arthrodesis for odontoid fractures: a systematic review and meta-analysis

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