Reevaluation of a classification system: stable and unstable odontoid fractures in geriatric patients—a radiological outcome measurement.
Objectives: We carried out a retrospective cohort study to differentiate geriatric odontoid fractures into stable and unstable and correlated it with fracture fusion rates. Results are based on the literature and on our own experience. The authors propose that the simple Anderson and D'Alonzo classi...
| Publicado en: | European Journal of Trauma & Emergency Surgery Vol. 48; no. 4; pp. 2967 - 2977 |
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| Autores principales: | , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Springer Nature
Aug2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=158431715&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 158431715 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18639933 3C05 jtl: European Journal of Trauma & Emergency Surgery issn: 18639933 maglogo: N pubinfo: dt: Aug2022 vid: 48 iid: 4 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 158431715 156970508 158431715 158431715 10.1007/s00068-022-01985-0 158431715 ppf: 2967 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Reevaluation of a classification system: stable and unstable odontoid fractures in geriatric patients—a radiological outcome measurement. aug: au: Deluca, Amelie Wichlas, Florian Deininger, Christian Traweger, Andreas Mueller, Ernst J. affil: Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria sug: subj: Cervical Vertebrae Radiography Spinal Fractures Classification Spinal Fractures Radiography Outcome Assessment Spinal Fractures Therapy Human Aged Aged, 80 and Over Retrospective Design Prospective Studies Male Female Spinal Fractures Surgery Spinal Fractures Drug Therapy Aged: 65+ years Aged, 80 & over Male Female ab: Objectives: We carried out a retrospective cohort study to differentiate geriatric odontoid fractures into stable and unstable and correlated it with fracture fusion rates. Results are based on the literature and on our own experience. The authors propose that the simple Anderson and D'Alonzo classification may not be sufficient for geriatric patients. Methods: There were 89 patients ≥ 65 years who presented at our institution with type II and III odontoid fractures from 2003 until 2017 and were included in this study. Each patient was categorized with CT scans to evaluate the type of fracture, fracture gap (mm), fracture angulation (°), fracture displacement (mm) and direction (ventral, dorsal). Fractures were categorized as stable [SF] or unstable [UF] distinguished by the parameters of its angulation (< / > 11°) and displacement (< / > 5 mm) with a follow-up time of 6 months. SFs were treated with a semi-rigid immobilization for 6 weeks, UFs surgically—preferably with a C1–C2 posterior fusion. Results: The classification into SFs and UFs was significant for its angulation (P = 0.0006) and displacement (P < 0.0001). SF group (n = 57): A primary stable union was observed in 35, a stable non-union in 10, and an unstable non-union in 8 patients of which 4 were treated with a C1/2 fixation. The overall consolidation rate was 79%. UF group (n = 32): A posterior C1–C2 fusion was carried out in 23 patients, a C0 onto C4 stabilization in 7 and an anterior odontoid screw fixation in 2. The union rate was 100%. Twenty-one type II SFs (91%) consolidated with a nonoperative management (P < 0.001). A primary non-union occurred more often in type II than in type III fractures (P = 0.0023). There was no significant difference in the 30-day overall case fatality (P = 0.3786). Conclusion: To separate dens fractures into SFs and UFs is feasible. For SFs, semi-rigid immobilization provides a high consolidation rate. Stable non-unions are acceptable, and the authors suggest a posterior transarticular C1–C2 fixation as the preferred surgical treatment for UFs. Level of evidence: Level III. pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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