title: Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures.
abstract: BACKGROUND
  Odontoid fractures are the most common cervical spine fractures in elderly patients. Treatment options included operative fixation (OP) or nonoperative management with either a halo-vest (HV) or rigid cervical orthosis (CO). Our previous study suggested increased morbidity and mortality with the use of HV in the treatment of elderly patients with cervical spine fractures. We review a series of odontoid fractures in elderly patients and evaluate for predictors for in-hospital morbidity and mortality.
  
  
  METHODS
  There were 78 patients >65 years of age who sustained a type II or III odontoid fracture from January 1997 to June 2004 identified from the Rhode Island Hospital Trauma registry. Demographic, mechanism, injury pattern, treatment, and outcome data were recorded. Patients were analyzed according to treatment method.
  
  
  RESULTS
  The mean age was 80.7 +/- 0.9 years. There were 50 type II, 17 type III, and 11 combined fractures. There were 38 (49%) patients treated with HV: 34 with halo alone, and 4 after OP; 40 (51%) patients were treated without HV: 27 with CO, and 13 with OP. There was no difference in injury severity or baseline medical condition between HV and non-HV patients. There were 24 (31%) patients who died during their hospital stay. Of the HV patients, 42% died compared with 20% in the non-HV group (p = 0.03). Major complications occurred in 66% of HV patients compared with 36% of non-HV patients (p = 0.003).
  
  
  CONCLUSIONS
  Odontoid fractures are associated with significant morbidity and mortality in elderly patients. Outcomes after treatment with HV appear inferior to those achieved with CO or OP.
authors.affiliation: Department of Surgery, Brown Medical School, Rhode Island Hospital, 2 Dudley Street, 170 Cooperative Care Building, Providence, RI 02905, USA. Rztashjian@hotmail.com
authors.forename: Robert Z
authors.initials: RZ
authors.lastname: Tashjian
authors.forename: Sarah
authors.initials: S
authors.lastname: Majercik
authors.forename: Walter L
authors.initials: WL
authors.lastname: Biffl
authors.forename: Mark A
authors.initials: MA
authors.lastname: Palumbo
authors.forename: William G
authors.initials: WG
authors.lastname: Cioffi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000293:injuries*; D009984:Orthopedic Fixation Devices; D009989:Orthotic Devices; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015599:Trauma Severity Indices; D016896:Treatment Outcome