Reevaluation of a classification system: stable and unstable odontoid fractures in geriatric patients—a radiological outcome measurement

European Journal of Trauma and Emergency Surgery, 2022 · DOI: 10.1007/s00068-022-01985-0 · Published: May 21, 2022

Simple Explanation

This study re-evaluates how odontoid fractures (fractures of a specific bone in the neck) in elderly patients are classified, differentiating them into stable and unstable fractures based on radiological measurements like angulation and displacement. Stable fractures were treated with a semi-rigid collar for six weeks, while unstable fractures were surgically treated, preferably with a C1-C2 posterior fusion (surgical stabilization of the top two vertebrae). The study found that using angulation and displacement measurements to classify these fractures is feasible and that semi-rigid immobilization provides a high consolidation rate for stable fractures.

Study Duration

2003 until 2017

Participants

89 patients ≥ 65 years with type II and III odontoid fractures

Evidence Level

Level III

Key Findings

1
The classification into SFs and UFs was significant for its angulation (P = 0.0006) and displacement (P < 0.0001).
2
A primary non-union occurred more often in type II than in type III fractures (P = 0.0023).
3
The overall consolidation rate of all UFs was 100%.

Research Summary

This retrospective cohort study aimed to differentiate geriatric odontoid fractures into stable (SFs) and unstable fractures (UFs) based on angulation and displacement, correlating this classification with fracture fusion rates. SFs were treated with semi-rigid immobilization, while UFs were primarily treated surgically, preferably with C1–C2 posterior fusion. The study found the classification to be significant and semi-rigid immobilization effective for SFs. The authors conclude that differentiating odontoid fractures into SFs and UFs is feasible, with semi-rigid immobilization providing high consolidation rates for SFs and posterior C1–C2 fixation being the preferred surgical treatment for UFs.

Practical Implications

Treatment Strategy

The study suggests a treatment algorithm where odontoid fractures in geriatric patients are first classified as stable or unstable based on radiological parameters (angulation and displacement).

Non-operative Management

For stable fractures, the study supports non-operative management using semi-rigid immobilization, indicating that not all type II fractures require surgery.

Surgical Intervention

For unstable fractures, posterior C1-C2 fixation is suggested as the preferred surgical method in geriatric patients due to its high fusion rate.

Study Limitations

1
Retrospective, non-randomized study design.
2
Data collected from documented electronic records with a median follow-up time of 6 months.
3
The degree of osteoporosis was not determined.

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