Nonoperative management of type II odontoid fractures in the elderly

Florentius Koech, Helen M Ackland, Dinesh K Varma, Owen D Williamson, Gregory M Malham
Spine 2008 December 15, 33 (26): 2881-6

STUDY DESIGN: Retrospective case series of elderly patients with Type II odontoid fractures, with prospective functional follow-up.

OBJECTIVE: We aimed to investigate the functional outcomes after nonoperative management of Type II odontoid fractures in elderly patients at a Level 1 trauma center.

SUMMARY OF BACKGROUND DATA: Controversy exists regarding the most appropriate method of treatment of Type II odontoid fractures in the elderly population. The primary aim of management has generally been considered to be the achievement of osseous fusion.

METHODS: Patients >or=65 years of age presenting to a Level 1 trauma center with Type II odontoid fractures were identified retrospectively from a prospective neurosurgery database. Those initially treated operatively, or who died before follow-up were excluded. Long-term pain and functional outcomes were assessed.

RESULTS: Forty-two patients were followed up at a median of 24 months post injury. Ten patients (24%) were treated in cervical collars alone and 32 patients (76%) were managed in halothoracic braces. Radiographically demonstrated osseous fusion occurred in 50% of patients treated in collars and in 37.5% of patients managed in halothoracic bracing. However, fracture stability was achieved in 90% and 100% of cases respectively. In patients treated in collars, 1 patient had severe residual neck pain, severe disability, and poor functional outcome. There were no cases of severe pain or disability, or poor functional outcome in patients managed in halothoracic orthoses. There was no difference in outcome in those achieving osseous union compared with stable fibrous union.

CONCLUSION: The nonoperative management of Type II odontoid fractures in elderly patients results in fracture stability, by either osseous union or fibrous union in almost all patients. Long-term clinical and functional outcomes seem to be more favorable when fractures have been treated with halothoracic bracing in preference to cervical collars. Stable fibrous union may be an adequate aim of management in elderly patients.

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