Evidence-based analysis of odontoid fracture management
T D Julien1, B Frankel, V C Traynelis
1Department of Neurosurgery, SUNY Health Science Center at Syracuse, Syracuse, New York, USA.
Neurosurgical Focus
|July 25, 2006
Summary
Current evidence is insufficient to establish guidelines for managing odontoid fractures. Further research is needed to determine optimal treatment for Type II fractures, while immobilization may suffice for Types I and III.
Area of Science:
- Orthopedic surgery
- Trauma care
- Spinal cord injury research
Background:
- Management of odontoid fractures lacks established standards.
- Evidence-based review is crucial for defining current practices.
Purpose of the Study:
- To review published data on odontoid fracture management using evidence-based methodology.
- To determine the current state of practices for odontoid fracture treatment.
Main Methods:
- Medline literature search (1966-1999) using keywords: "odontoid," "odontoid fracture," "cervical fracture."
- Articles graded using a four-tiered system; 95 articles reviewed.
- Evidentiary tables constructed by treatment type for fracture classification (Type I, II, III).
Main Results:
- All reviewed studies contained Class III data.
- Five articles for Type I, 16 for Type II, and 14 for Type III met selection criteria.
- Insufficient evidence exists to establish a definitive management standard or guideline.
Conclusions:
- A well-designed case-controlled study could establish guidelines for Type I and III fractures, suggesting 6-8 weeks of cervical immobilization.
- For Type II fractures, both operative and nonoperative management remain options based on Class III evidence.
- Randomized trials or serial case-controlled studies are required to establish guidelines or standards for Type II odontoid fractures.
