title: A comparison of anterior screw fixation and halo immobilisation of type II odontoid fractures in elderly patients at increased risk from anaesthesia.
abstract: OBJECTIVE
  We performed a retrospective, comparative study of elderly patients with an increased risk from anaesthesia who had undergone either anterior screw fixation (ASF) or halo vest immobilisation (HVI) for a type II odontoid fracture.
  
  
  METHODS
  A total of 80 patients aged 65 years or more who had undergone either ASF or HVI for a type II odontoid fracture between 1988 and 2013 were reviewed. There were 47 women and 33 men with a mean age of 73 (65 to 96; standard deviation 7). All had an American Society of Anesthesiologists score of 2 or more.
  
  
  RESULTS
  Patients who underwent ASF had a significantly better outcome than those who were treated by HVI. There was a rate of nonunion of 10% after ASF and 23% after HVI. Failure of reduction or fixation occurred in 11 patients (15%) but there was no significant difference between the two groups. Mortality rates were also similar: 9% (n = 3) after ASF and 8% (n = 4) after HVI.
  
  
  CONCLUSIONS
  We conclude that ASF is the preferred method of treatment in this group of elderly patients, having a significantly higher rate of fusion, better clinical outcome and a similar rate of general and treatment-related complications. Cite this article: Bone Joint J 2016;98-B:1222-6.
authors: Medical University of Vienna, Währingergürtel, 18-20, 1090 Vienna, Austria, 1090, Austria.
authors: J
authors: J
authors: Joestl
authors: Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors: N
authors: N
authors: Lang
authors: Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors: A
authors: A
authors: Bukaty
authors: Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors: P
authors: P
authors: Platzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D001863:Bone Screws; D001915:Braces; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment; D006801:Humans; D007103:Immobilization / Q000295:instrumentation / Q000379:methods*; D015601:Injury Severity Score; D008297:Male; D009809:Odontoid Process / Q000293:injuries*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016103:Spinal Fractures / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D014143:Traction / Q000379:methods; D014193:Trauma Centers
keywords: Anaesthetic risk; Anterior screw fixation; Geriatric patients; Halo immobilisation; Odontoid fractures