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Odontoid fractures in the elderly: should we operate?
Alice M Fagin1, Mark D Cipolle, Robert D Barraco
1Department of Surgery, Division of Trauma/Surgical Critical Care, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
The Journal of Trauma
|December 10, 2009
Summary
Nonoperative management of odontoid fractures in elderly patients shows similar mortality and complication rates compared to operative fixation. Nonoperative treatment also reduced hospital length of stay and ventilator days, suggesting it should be strongly considered.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Geriatric medicine
Background:
- Treatment for odontoid fractures is controversial, with varied approaches regarding operative fixation (OP).
- Management decisions often depend on surgeon preference, leading to inconsistent care.
- This study aimed to establish management consensus for elderly patients with odontoid fractures by comparing operative and nonoperative outcomes.
Purpose of the Study:
- To compare outcomes of operative fixation (OP) versus nonoperative (non-OP) management in elderly patients (age ≥ 60) with odontoid fractures.
- To identify optimal treatment strategies for this patient population.
- To reduce variability in treatment decisions within institutions.
Main Methods:
- Retrospective review of elderly patients with odontoid fractures from a level I trauma center (2000-2006).
- Patients were categorized into early-OP (<3 days), late-OP (>3 days), and non-OP groups.
- Outcomes assessed included mortality, ventilator days, hospital length of stay (HLOS), need for tracheostomy/PEG, and complications (UTI, DVT, pneumonia).
Main Results:
- Non-OP patients were significantly older than operative groups (mean age 82.4 vs. 76.4-77.4 years).
- No significant differences in mortality, tracheostomy/PEG rates, UTI, or pneumonia were observed among groups.
- Non-OP management resulted in fewer deep vein thromboses (DVTs) compared to early-OP, reduced ventilator days, and shorter HLOS.
Conclusions:
- Nonoperative management of odontoid fractures in elderly patients yields comparable mortality and major complication rates to operative fixation.
- Nonoperative treatment is associated with decreased HLOS and ventilator days, and lower DVT rates compared to early operative intervention.
- Nonoperative management should be strongly considered for elderly patients with traumatic odontoid fractures.
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