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Odontoid fractures in elderly patients

W C Hanigan1, F C Powell, P W Elwood

  • 1Department of Neuroscience, University of Illinois College of Medicine, Peoria.

Journal of Neurosurgery
|January 1, 1993
PubMed
Summary

Elderly patients with odontoid fractures often result from falls. While some non-operative treatments lead to stable non-union, surgical fusion offers better outcomes for unstable fractures in this age group.

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Area of Science:

  • Orthopedics
  • Geriatric Medicine
  • Trauma Surgery

Background:

  • Odontoid fractures are complex injuries, particularly in elderly patients (≥80 years).
  • Falls are the predominant cause of these fractures in this demographic.

Purpose of the Study:

  • To analyze the clinical features, management strategies, and outcomes of odontoid fractures in geriatric patients.
  • To compare the effectiveness of non-operative versus operative treatments for odontoid fractures in patients aged 80 years and older.

Main Methods:

  • Retrospective analysis of 19 patients (≥80 years) with odontoid fractures.
  • Categorization of fractures by type (II and III) and displacement.
  • Review of treatment approaches: cervical immobilization versus posterior cervical fusion (C1-2).

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Main Results:

  • Most fractures (16/19) were Type II, primarily caused by falls (15/19).
  • Non-operative treatment showed stable non-union in 3/8 patients with minimal displacement; however, 3/4 patients not surgically treated died from unrelated causes.
  • Surgical posterior cervical fusion (C1-2) in 5 patients with instability resulted in stable constructs and no operative complications, with all survivors resuming normal activity.

Conclusions:

  • Elderly patients with odontoid fractures face significant mortality risks, often exacerbated by prolonged bed rest and comorbidities.
  • Non-operative management may lead to stable non-union in select cases, but surgical fusion is effective for unstable fractures, offering good outcomes without operative morbidity or mortality.
  • Careful consideration of treatment strategies is crucial for optimizing outcomes in this vulnerable patient population.