Odontoid fractures, with special reference to the elderly patient

Area of Science:

• Orthopedics
• Neurosurgery
• Trauma Surgery

Background:

• Odontoid fractures represent a significant subset of cervical spine injuries.
• Demographic and etiologic factors vary with patient age.

Purpose of the Study:

• To analyze the characteristics, management, and outcomes of odontoid fractures.
• To identify factors influencing healing and nonunion rates.

Main Methods:

• Retrospective review of 262 cervical spine fractures.
• Analysis of 41 odontoid fractures, including demographics, injury mechanisms, fracture types (Anderson-D'Alonzo), displacement, and treatment modalities.
• Evaluation of healing times, nonunion rates, and treatment tolerance.

Main Results:

• 16% of cervical spine fractures were odontoid fractures.
• Younger patients (<40) often sustained fractures from motor vehicle accidents, while older patients (>60) typically fell.
• Anderson-D'Alonzo Types II and III were most common (19 and 21 patients, respectively).
• Significant displacement occurred in 31 patients, with anterior displacement more common in younger patients and posterior displacement in older patients.
• Nonunion rates were higher in Type II (7/13) and Type III (2/13) fractures treated conservatively.
• Halothoracic jackets were poorly tolerated in patients over 75.

Conclusions:

• Odontoid fracture characteristics and causes differ by age group.
• Conservative management has a notable nonunion rate, particularly for Type II fractures.
• Early C1-2 fusion or bracing may be superior for elderly patients, especially when daily supervision is challenging.