Early complications of surgical versus conservative treatment of isolated type II odontoid fractures in octogenarians: a retrospective cohort study.
METHODS
A retrospective cohort study of operative versus nonoperative treatment of isolated type II odontoid fractures in patients aged 80 years and more without neurologic deficit admitted to a level 1 spinal cord injury center between June 1985 and July 2006.


OBJECTIVE
To assess the presentation and acute complications of operatively and nonoperatively managed type II odontoid fractures in the octogenarian population.


BACKGROUND
Type II odontoid fractures are the most common cervical spine fracture in the elderly. Studies suggest acute in-hospital complication rates in type II odontoid fractures in the elderly exceed 50%. Few studies have examined the acute in-hospital outcomes of isolated type II odontoid fractures in the octogenarian population.


METHODS
The medical records of 223 consecutive C2 fractures from June 1985 to July 2006 over the age of 80 years were reviewed retrospectively. Patients with associated cervical spine fractures were excluded. Eighty neurologically intact patients over age 80 were identified with isolated acute type II odontoid fractures. The charts were reviewed and mechanism of injury, comorbidities, date of injury, date of admission, date of discharge, radiology reports, discharge disposition, associated injuries, fracture management, type of surgical fixation (if any), and documented complications were abstracted.


RESULTS
Thirty-two patients received operative treatment (10 anterior and 22 posterior) and 40 patients received nonsurgical treatment. Eight patients were excluded because the medical record could not be located. The mean age was 85.5+/-3.5 years in the surgical and 87.3+/-4.7 years in the nonsurgical group (P>0.05); mean length of acute hospital stay was 11.2+/-8.5 days in the nonsurgical and 22.8+/-28.3 days in the surgical group (P<0.05); mean comorbidity score was 2.3+/-1.2 in the nonsurgical and 2.0+/-1.0 in the surgical group (P>0.5); mean fracture displacement was 4.1+/-3.5 mm in the nonsurgical and 3.9+/-3.4 mm in the surgical group (P>0.5). Acute in-hospital mortality rate was 15% in the nonsurgical group and 12.5% in the surgical group (P>0.05). The percentage of patients experiencing at least one significant complication was higher in the operative group than the nonoperative group (62% vs. 35%, respectively, P<0.05).


CONCLUSIONS
Type II odontoid fractures in the octogenarian population are associated with substantial morbidity and mortality, irrespective of management method. Prospective studies are needed to better elucidate management strategies for this difficult clinical problem.
Smith
Harvey E
HE
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Kerr
Stewart M
SM
Maltenfort
Mitchell
M
Chaudhry
Sonia
S
Norton
Robert
R
Albert
Todd J
TJ
Harrop
James
J
Hilibrand
Alan S
AS
Anderson
D Greg
DG
Kopjar
Branko
B
Brodke
Darrel S
DS
Wang
Jeffrey C
JC
Fehlings
Michael G
MG
Chapman
Jens R
JR
Patel
Archit
A
Arnold
Paul M
PM
Vaccaro
Alexander R
AR
D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology* / Q000628:therapy*; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology