title: Survival analysis of elderly patients with a fracture of the odontoid peg.
abstract: Fractures of the odontoid peg are common spinal injuries in the elderly. This study compares the survivorship of a cohort of elderly patients with an isolated fracture of the odontoid peg versus that of patients who have sustained a fracture of the hip or wrist. A six-year retrospective analysis was performed on all patients aged > 65 years who were admitted to our spinal unit with an isolated fracture of the odontoid peg. A Kaplan-Meier table was used to analyse survivorship from the date of fracture, which was compared with the survivorship of similar age-matched cohorts of 702 consecutive patients with a fracture of the hip and 221 consecutive patients with a fracture of the wrist. A total of 32 patients with an isolated odontoid fracture were identified. The rate of mortality was 37.5% (n = 12) at one year. The period of greatest mortality was within the first 12 weeks. Time made a lesser contribution from then to one year, and there was no impact of time on the rate of mortality thereafter. The rate of mortality at one year was 41.2% for male patients (7 of 17) compared with 33.3% for females (5 of 15). The rate of mortality at one year was 32% (225 of 702) for patients with a fracture of the hip and 4% (9 of 221) for those with a fracture of the wrist. There was no statistically significant difference in the rate of mortality following a hip fracture and an odontoid peg fracture (p = 0.95). However, the survivorship of the wrist fracture group was much better than that of the odontoid peg fracture group (p < 0.001). Thus, a fracture of the odontoid peg in the elderly is not a benign injury and is associated with a high rate of mortality, especially in the first three months after the injury.
authors.affiliation: University Hospitals of Leicester, Infirmary Square, Leicester LE1 5WW, UK.
authors.forename: M
authors.initials: M
authors.lastname: Venkatesan
authors.forename: J R
authors.initials: JR
authors.lastname: Northover
authors.forename: J B
authors.initials: JB
authors.lastname: Wild
authors.forename: N
authors.initials: N
authors.lastname: Johnson
authors.forename: K
authors.initials: K
authors.lastname: Lee
authors.forename: C E
authors.initials: CE
authors.lastname: Uzoigwe
authors.forename: J R
authors.initials: JR
authors.lastname: Braybrooke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000401:mortality; D006620:Hip Fractures / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009809:Odontoid Process / Q000293:injuries*; D011379:Prognosis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000401:mortality* / Q000628:therapy; D014954:Wrist Injuries / Q000401:mortality
keywords: C2; Fracture; Hip; Mortality; Odontoid process; Peg; Wrist