Type II Fractures in Older Adults: Can They Be Treated Conservatively?

Aquila, Filippo; Tacconi, Leonello; Baldo, Sara

doi:10.1016/j.wneu.2018.07.105

Cited by 9 publications

(3 citation statements)

References 21 publications

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“…The fracture type and configuration (angulation and translation) did not differ between the groups, thus suggesting that this may not be a deciding factor between collar types in this population. Unlike other studies and reviews on nonoperative management, 15,16,[18][19][20][21][22][23] we included all fracture types to assess if these groups could also be affectively treated with a soft collar and not just the hard collar option. As such, we note that older patients with type I and III fractures can potentially also be treated non-operatively in soft as well as hard collars.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…Historically, the halo vest was used for maintaining cervical in-line stabilization for healing but require precise pin placement and have risks of infection, nerve/brain damage, and provide the patient with pain and tissue breakdown beneath the torso, and functional limitation and poor compliance [4,[6][7][8]. Semi-rigid collars were shown to have fewer complications, with similar or improved fracture union (>70% semi-rigid vs 40% HV) [4,6,8,9]. Differing opinions exist to whether only full osseous fusion or including asymptomatic pseudoarthrosis are considered sufficient in goals of care with these fractures.…”

Section: Discussionmentioning

confidence: 99%

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

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Doan

Vanier

et al. 2022

Preprint

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Background: Odontoid fractures are common and projected to increase. Comorbidities compound risk of surgery and balancing the risk of non-operative management is controversial. Stable fractures are managed based on patient comorbidity with suspected clinical prognosis. Type I and III fractures are typically managed safely with cervical orthoses. Management decisions of type II fractures however, come under frequent debate. This paper evaluates overall morbidity and mortality, and outcomes of operative and non-operative management. Methods: We performed national database review of C2 fractures from January 2014 to December 2019. Patients were divided into categories based on Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). Outcomes data considered hospital admission, Intensive Care Unit (ICU) admission, hospital length of stay (LOS), ICU LOS, and mortality. Logistic regression was used for mortality, hospital admission, and ICU admission. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from the logistic regression models. The Kruskal-Wallis test was used to compare the hospital and ICU LOS based on surgery overall, and by GCS and ISS. Results: 42,003 patients were identified, 9,187 had surgery with overall mortality rate of 0.7%. There was a younger operative median age (67) and interquartile range (IQR: 47, 78) than non-operative group (73, IQR: 56, 83). Both had the same median ISS score (10). Surgery was associated with lower rates of mortality, from 0.1% to 0.9% mortality for non-operative. Mild or moderate GCS mortality improved operative (0.07%) to non-operative (0.23%). Severe GCS patients with surgery had significantly improved mortality rates patients without (0.29% vs 7.69%, respectively). Surgery increased ICU admissions for every ISS category. Severe GCS had higher chances of ICU admission, but no interaction with surgery. Operative patients had longer hospital and ICU stays. For all GCS and ISS categories, hospital and ICU LOS was longer for operative patients. Conclusions: This review demonstrates significant improvement in mortality with operative management. Standard non-operative management of type I and III C2 fractures is appropriate. Surgeons should consider operating on type II odontoid fractures unless patient cannot undertake the surgical risks of induction with general anesthesia. Level of evidence: Level IV

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“…Historically, the halo vest was used for maintaining cervical in-line stabilization for healing but require precise pin placement and have risks of infection, nerve/brain damage, and provide the patient with pain and tissue breakdown beneath the torso, and functional limitation and poor compliance [4,[6][7][8]. Semi-rigid collars were shown to have fewer complications, with similar or improved fracture union (>70% semi-rigid vs 40% HV) [4,6,8,9]. Differing opinions exist to whether only full osseous fusion or including asymptomatic pseudoarthrosis are considered su cient in goals of care with these fractures.…”

Section: Los In Hospital and Icumentioning

confidence: 99%

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

Foote

Doan

Vanier

et al. 2022

Preprint

View full text Add to dashboard Cite

Background:Odontoid fractures are common and projected to increase. Comorbidities compound risk of surgery and balancing the risk of non-operative management is controversial. Stable fractures are managed based on patient comorbidity with suspected clinical prognosis. Type I and III fractures are typically managed safely with cervical orthoses. Management decisions of type II fractures however, come under frequent debate. This paper evaluates overall morbidity and mortality, and outcomes of operative and non-operative management. Methods:We performed national database review of C2 fractures from January 2014 to December 2019. Patients were divided into categories based on Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). Outcomes data considered hospital admission, Intensive Care Unit (ICU) admission, hospital length of stay (LOS), ICU LOS, and mortality. Logistic regression was used for mortality, hospital admission, and ICU admission. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from the logistic regression models. The Kruskal-Wallis test was used to compare the hospital and ICU LOS based on surgery overall, and by GCS and ISS.Results:42,003 patients were identified, 9,187 had surgery with overall mortality rate of 0.7%. There was a younger operative median age (67) and interquartile range (IQR: 47, 78) than non-operative group (73, IQR: 56, 83). Both had the same median ISS score (10). Surgery was associated with lower rates of mortality, from 0.1% to 0.9% mortality for non-operative. Mild or moderate GCS mortality improved operative (0.07%) to non-operative (0.23%). Severe GCS patients with surgery had significantly improved mortality rates patients without (0.29% vs 7.69%, respectively). Surgery increased ICU admissions for every ISS category. Severe GCS had higher chances of ICU admission, but no interaction with surgery. Operative patients had longer hospital and ICU stays. For all GCS and ISS categories, hospital and ICU LOS was longer for operative patients.Conclusions:This review demonstrates significant improvement in mortality with operative management. Standard non-operative management of type I and III C2 fractures is appropriate. Surgeons should consider operating on type II odontoid fractures unless patient cannot undertake the surgical risks of induction with general anesthesia.Level of evidence: Level IV

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Type II Fractures in Older Adults: Can They Be Treated Conservatively?

Cited by 9 publications

References 21 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

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

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