title: Surgical vs nonoperative treatment of Hadley type IIA odontoid fractures.
abstract: BACKGROUND
  Type II odontoid fractures with additional chip fragments are rare in clinical practice, accounting for < 10% of all odontoid fractures. Hadley et al were the first to describe these fractures as an individual subtype (IIA).
  
  
  OBJECTIVE
  To analyze the outcome of patients after surgical or nonoperative treatment of Hadley type IIA odontoid fractures.
  
  
  METHODS
  We analyzed the records of 46 patients at an average of 64 years of age at the time of injury. Twenty-five patients underwent surgical stabilization by anterior screw fixation and were entered into study group A; 21 patients were treated nonoperatively by halo vest immobilization and included in study group B.
  
  
  RESULTS
  Thirty-seven patients (84%) returned to their preinjury activity level and were satisfied with their treatment. Using the Cervical Spine Outcomes Questionnaire to quantify the clinical outcome, we had an overall outcome score of 21.8. We did not find a significant difference in the overall clinical outcome between study groups. Bony fusion was achieved in 35 patients (80%). We had a nonunion rate of 13% after anterior screw fixation and a significantly higher rate of 30% after halo vest immobilization. Failure of reduction or fixation occurred in 12 patients (27%), with a significantly higher failure rate after halo vest immobilization.
  
  
  CONCLUSIONS
  Hadley type IIA odontoid fractures are inherently unstable and impede proper realignment. These fractures have a significantly increased risk for secondary loss of reduction and bony nonunion, particularly after nonoperative management. Early surgery should be considered to avoid further complications.
authors.affiliation: Medical University of Vienna, Department of Trauma Surgery, Vienna, Austria.
authors.forename: Silke
authors.initials: S
authors.lastname: Aldrian
authors.forename: Jochen
authors.initials: J
authors.lastname: Erhart
authors.forename: Rupert
authors.initials: R
authors.lastname: Schuster
authors.forename: Simon
authors.initials: S
authors.lastname: Wernhart
authors.forename: Florian
authors.initials: F
authors.lastname: Domaszewski
authors.forename: Roman
authors.initials: R
authors.lastname: Ostermann
authors.forename: Harald
authors.initials: H
authors.lastname: Widhalm
authors.forename: Patrick
authors.initials: P
authors.lastname: Platzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D016208:Databases, Factual / Q000706:statistics & numerical data; D016267:External Fixators / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012307:Risk Factors; D016103:Spinal Fractures / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome