Type II Odontoid Fractures in the Elderly
Type II Odontoid Fractures in the Elderly
The optimum treatment of Type II odontoid fractures in the geriatric population remains controversial. Coexisting medical conditions encountered in the elderly patient often increase operative risk and make cervical immobilization difficult to tolerate. Previous studies have shown increased morbidity and mortality and decreased fusion rates for Type II odontoid fractures treated with cervical orthoses in the geriatric population, whereas low morbidity and mortality rates with operative management have recently been documented. To investigate the role of surgical and nonsurgical treatment, a retrospective analysis was performed of patients with Type II odontoid fractures who were at least 65 years old and were consecutively admitted to a single medical center from 1994 to 1998. Twenty patients met inclusion criteria. In 12 patients nonsurgical management with a cervical orthosis was attempted. The nonsurgical management failed early in six patients, with one associated death. Eleven patients were treated surgically with either anterior odontoid screw fixation or posterior C1-2 transarticular screw fixation and modified Gallie fusion. Postoperatively one patient required revision of the C1-2 transarticular screws, and there was one death. In conclusion Type II odontoid fractures in this elderly population were associated with early 10% morbidity and 20% mortality rates. Nonsurgical management of Type II odontoid fractures failed early in six (50%) of 12 patients, whereas surgical treatment failed early in one of 11 (9%) patients. Both the nonsurgical and surgical treatments resulted in approximately 10% morbidity and 10% mortality rates.
The optimum treatment of Type II odontoid fractures in the elderly remains controversial. The medical frailty of the geriatric patient often compromises treatment, increasing the risks of both nonsurgical management with a cervical orthosis and surgical treatment with internal fixation and fusion. Surgical and nonsurgical treatment of odontoid fractures in the elderly is associated with higher morbidity and mortality rates when compared with younger patients with similar injuries.
Authors of recent investigations have reported that prolonged cervical immobilization in a halothoracic vest is often not well tolerated by the geriatric patient, leading to increased morbidity and mortality rates and a high rate of nonunion, while authors of contemporary reports of surgically treated Type II odontoid fractures in the elderly have found acceptably low morbidity and mortality rates with a high rate of union. To further investigate the role of surgical and nonsurgical treatment of Type II odontoid fractures in the elderly, we retrospectively reviewed the records of all patients aged 65 years or older in whom a diagnosis of Type II odontoid fracture had been made and who were admitted to Harborview Medical Center between 1994 and 1998.
The optimum treatment of Type II odontoid fractures in the geriatric population remains controversial. Coexisting medical conditions encountered in the elderly patient often increase operative risk and make cervical immobilization difficult to tolerate. Previous studies have shown increased morbidity and mortality and decreased fusion rates for Type II odontoid fractures treated with cervical orthoses in the geriatric population, whereas low morbidity and mortality rates with operative management have recently been documented. To investigate the role of surgical and nonsurgical treatment, a retrospective analysis was performed of patients with Type II odontoid fractures who were at least 65 years old and were consecutively admitted to a single medical center from 1994 to 1998. Twenty patients met inclusion criteria. In 12 patients nonsurgical management with a cervical orthosis was attempted. The nonsurgical management failed early in six patients, with one associated death. Eleven patients were treated surgically with either anterior odontoid screw fixation or posterior C1-2 transarticular screw fixation and modified Gallie fusion. Postoperatively one patient required revision of the C1-2 transarticular screws, and there was one death. In conclusion Type II odontoid fractures in this elderly population were associated with early 10% morbidity and 20% mortality rates. Nonsurgical management of Type II odontoid fractures failed early in six (50%) of 12 patients, whereas surgical treatment failed early in one of 11 (9%) patients. Both the nonsurgical and surgical treatments resulted in approximately 10% morbidity and 10% mortality rates.
The optimum treatment of Type II odontoid fractures in the elderly remains controversial. The medical frailty of the geriatric patient often compromises treatment, increasing the risks of both nonsurgical management with a cervical orthosis and surgical treatment with internal fixation and fusion. Surgical and nonsurgical treatment of odontoid fractures in the elderly is associated with higher morbidity and mortality rates when compared with younger patients with similar injuries.
Authors of recent investigations have reported that prolonged cervical immobilization in a halothoracic vest is often not well tolerated by the geriatric patient, leading to increased morbidity and mortality rates and a high rate of nonunion, while authors of contemporary reports of surgically treated Type II odontoid fractures in the elderly have found acceptably low morbidity and mortality rates with a high rate of union. To further investigate the role of surgical and nonsurgical treatment of Type II odontoid fractures in the elderly, we retrospectively reviewed the records of all patients aged 65 years or older in whom a diagnosis of Type II odontoid fracture had been made and who were admitted to Harborview Medical Center between 1994 and 1998.
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