title: Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation.
abstract: BACKGROUND
  Anterior odontoid screw fixation (AOSF) has been one of the most popular treatments for odontoid fractures. However, the true efficacy of AOSF remains unclear. In this study, we aimed to provide the pooled rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid fractures.
  
  
  METHODS
  We searched studies that discussed complications after AOSF for type II or type III odontoid fractures. A proportion meta-analysis was done and potential sources of heterogeneity were explored by meta-regression analysis.
  
  
  RESULTS
  Of 972 references initially identified, 63 were eligible for inclusion. 54 studies provided data regarding non-union. The pooled non-union rate was 10% (95% CI: 7%-3%). 48 citations provided re-operation information with a pooled proportion of 5% (95% CI: 3%-7%). Infection was described in 20 studies with an overall rate of 0.2% (95% CI: 0%-1.2%). The main approach related complication is postoperative dysphagia with a pooled rate of 10% (95% CI: 4%-17%). Proportions for the other approach related complications such as postoperative hoarseness (1.2%, 95% CI: 0%-3.7%), esophageal/retropharyngeal injury (0%, 95% CI: 0%-1.1%), wound hematomas (0.2%, 95% CI: 0%-1.8%), and spinal cord injury (0%, 95% CI: 0%-0.2%) were very low. Significant heterogeneities were detected when we combined the rates of non-union, re-operation, and dysphagia. Multivariate meta-regression analysis showed that old age was significantly predictive of non-union. Subgroup comparisons showed significant higher non-union rates in age ≥ 70 than that in age ≤ 40 and in age 40 to <50. Meta-regression analysis did not reveal any examined variables influencing the re-operation rate. Meta-regression analysis showed age had a significant effect on the dysphagia rate.
  
  
  CONCLUSIONS
  This study summarized the rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid fractures. Elderly patients were more likely to experience non-union and dysphagia.
authors: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors: Nai-Feng
authors: NF
authors: Tian
authors: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors: Xu-Qi
authors: XQ
authors: Hu
authors: Institute of Digitized Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors: Li-Jun
authors: LJ
authors: Wu
authors: Institute of Digitized Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors: Xin-Lei
authors: XL
authors: Wu
authors: Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Yao-Sen
authors: YS
authors: Wu
authors: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Center for Stem Cells and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Xiao-Lei
authors: XL
authors: Zhang
authors: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors: Xiang-Yang
authors: XY
authors: Wang
authors: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors: Yong-Long
authors: YL
authors: Chi
authors: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors: Fang-Min
authors: FM
authors: Mao
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001863:Bone Screws; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007572:Jaw Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000209:etiology / Q000503:physiopathology*; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome