title: Management and Outcome of Dens Fracture Nonunions in Geriatric Patients.
abstract: BACKGROUND
  Dens fractures are known to have high rates of pseudarthrosis. The aim of this study was to define clinical and radiographic long-term outcomes, specifically in relation to osseous union, cervical spine movement, neurological sequelae, and quality of life, in a geriatric cohort (sixty-five years of age or older) treated operatively or nonoperatively for a dens fracture nonunion.
  
  
  METHODS
  Forty-four patients (twenty-eight women and sixteen men; average age, seventy-two years) met the inclusion criteria and were enrolled in this study. Sixteen patients (36%) underwent operative stabilization with posterior cervical arthrodesis, and twenty-eight (64%) were treated nonoperatively with a predefined protocol. All patients had a post-treatment follow-up period of at least five years.
  
  
  RESULTS
  Radiographic evaluation showed osseous union at the site of the C1-C2 arthrodesis in all sixteen patients who had undergone surgical treatment. Clinical follow-up revealed that fourteen had satisfactory results following postoperative rehabilitation. In contrast, radiographic evaluation of the twenty-eight nonoperatively treated patients showed persistence of the pseudarthrosis of the dens in twenty-six and osseous union of the dens in two. All twenty-eight patients (100%) had a satisfactory clinical outcome.
  
  
  CONCLUSIONS
  C1-C2 arthrodesis was a reliable treatment option for dens fracture nonunions that were unstable, those associated with neurological symptoms, and those causing persistent pain. Clinical and radiographic monitoring was an acceptable nonoperative treatment option but was associated with a very low rate of osseous union of the dens.
authors: Department of Trauma Surgery, Medical University of Vienna, Austria julian.joestl@meduniwien.ac.at.
authors: Julian
authors: J
authors: Joestl
authors: Department of Trauma Surgery, Medical University of Vienna, Austria.
authors: Nikolaus W
authors: NW
authors: Lang
authors: Department of Trauma Surgery, Medical University of Vienna, Austria.
authors: Thomas M
authors: TM
authors: Tiefenboeck
authors: Department of Trauma Surgery, Medical University of Vienna, Austria.
authors: Stefan
authors: S
authors: Hajdu
authors: Department of Trauma Surgery, Medical University of Vienna, Austria.
authors: Patrick
authors: P
authors: Platzer
mesh_terms: D000368:Aged; D001174:Arthrodesis; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000293:injuries*; D011183:Postoperative Complications; D011542:Pseudarthrosis / Q000209:etiology; D011859:Radiography; D012678:Sensation Disorders / Q000209:etiology; D013119:Spinal Cord Injuries / Q000209:etiology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome