Comparative Effectiveness of Conservative Management Versus Surgical Fixation in Acute Type II Odontoid Fractures

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Trauma Care

Background:

• Managing acute type II odontoid fractures in elderly patients presents significant challenges due to comorbidities and frailty.
• This demographic often experiences poorer outcomes, necessitating careful treatment evaluation.

Purpose of the Study:

• To compare the radiological and functional outcomes of conservative versus surgical management for acute type II odontoid fractures in the elderly.
• To identify predictors of fracture union in this patient population.

Main Methods:

• Retrospective analysis of elderly patients with acute type II odontoid fractures (2015-2023) at a single US institution.
• Bivariate and logistic regression analyses were employed to compare outcomes and predict union.
• 253 patients with available outcome data were analyzed, with 235 receiving conservative treatment and 18 undergoing surgical fixation.

Main Results:

• Surgical fixation was associated with significantly higher fracture union rates (44% vs. 10%, P < .01).
• Functional outcomes, measured by Modified Rankin Scale ≤2, were similar between groups (75% vs. 73%, P = .85).
• Conservative treatment demonstrated superior pain control (75% excellent vs. 47% for surgery, P < .01).
• Predictors of union included surgical fixation (aOR=6.6), while advanced age (≥80), smoking, osteoporosis, frailty, and angulation (≥11°) were negatively associated.

Conclusions:

• Surgical fixation is a strong predictor of fracture union in elderly patients with type II odontoid fractures.
• Conservative management provides better pain control and comparable long-term functional outcomes.
• Treatment decisions should balance the benefits of surgical union with the advantages of conservative care regarding pain and frailty.