Odontoid fractures, with special reference to the elderly patient. x

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Pepin JW. Bourne RB. Hawkins RJ. x Clinical Orthopaedics & Related Research. [JC:dfy] (193):178-83, 1985 Mar. x A retrospective review of 262 consecutive cervical spine fractures x revealed that 41 (16%) were odontoid fractures. Twenty patients were x younger than 40 years of age (19 fractures were the result of a motor x vehicle accident), whereas 19 fractures occurred in subjects older than 60 x (13 were the result of a fall). Fractures were of the Anderson-D'Alonzo x Types I (one patient), II (19 patients), and III (21 patients). x Significant displacement was present in 31 patients. Anterior and x posterior displacement occurred equally, but most of the anterior x fractures were seen in patients younger than 40, and the majority of the x posterior fractures occurred in those older than 60. Primary fusion was x performed in 12 cases. Conservative management was used in 26. Three x patients died (one from a spinal cord transection and two from other x injuries). In the conservatively treated group, the average time to x healing was 12 weeks, but the overall nonunion rate was nine out of 26 x (7/13 Type II, 2/13 Type III fractures). The halothoracic jacket was x poorly tolerated in patients older than 75 years of age. If daily x supervision is not possible, early C1-2 fusion or treatment in an x appropriate brace seems superior in the elderly patient. x