A broken neck: outcomes from conservative management of C2 fractures in older adults

To describe the management, complications and functional outcomes of older patients who sustain fractures of the second cervical vertebra (C2).

Retrospective review of consecutive patients aged 65 years and older. All patients admitted with the clinical discharge code of S12.1 (fracture of second cervical vertebra) to Christchurch Hospital, New Zealand, over five years were included. Outcomes of mobility, domicile and mortality (inpatient, 30 days, one year and two years) were recorded, as well as all complications from injury and from treatment.

Sixty-four patients (26 male, 38 female) with a mean age of 80.6 years were included. On admission, 89% of patients lived at home, 25% used a mobility aid and the median Charlson Comorbidity Index score was 2.0. All patients were managed conservatively (non-surgically) with majority immobilised in a rigid collar (46, 72%). Thirty-seven (58%) received inpatient rehabilitation. Complications were common, with medical (n=39 (61%)) and collar complications (37 (58%), mainly pain and pressure related) the most frequent. Mortality was 9% in hospital and 22% at one year. Of the 57 patients living in their own homes prior to fracture, 43 (75%) were able to return home. More patients required a mobility aid on discharge compared with on admission (25% vs 70%, Chi square=43, p<0.0001).

C2 fractures in older people cause substantial morbidity and loss of function in older patients. Despite the majority needing inpatient rehabilitation and complications related to the collar or immobility being common, three-quarters of patients were still able to return home. Walking ability declined and most needed some walking aid post fracture.