A stable fracture may “set” and heal itself. In a stable fracture, the bone does not move out of its normal anatomical position and alignment. Some fractures are considered stable, and some are unstable. In a Type III fracture, the bone is broken below the base of the peg. In a Type II fracture, the most common type, the peg is broken at its base. In a Type I odontoid fracture, just the tip of the bone is broken. In an odontoid fracture, that peg of bone is broken. The odontoid process sticks up from the front of C2 and fits into a groove in C1. It is about the size of the tip of a pinky finger. One of the unique features of this joint is a peg of bone called the odontoid process (sometimes called the dens ). This is the joint that allows the head to rotate from side to side, bend forward and bend backward. The joint between C2 and the vertebra above, C1, has an outstanding range of motion. The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. Poor outcome is associated with spinal cord injury, GCS score, AIS score, and ISS.ĪIS = Abbreviated Injury Scale GCS = Glasgow Coma Scale ISS = Injury Severity Score SCI = spinal cord injury Type II odontoid fracture cervical elderly populations nonoperative management spine trauma.Odontoid = A peg-like part of the second bone in the neck Fracture = A break in a boneĪ type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck.īones of the spine are called vertebrae. CONCLUSIONS Type II odontoid fracture is associated with high morbidity among octogenarians, with 41% 1-year mortality independent of intervention-a dramatic decrease from actuarial survival rates for all 80-, 90-, and 100-year-old Americans. The rate of nonhome disposition was not significant between the groups. Additional cervical fracture was not associated with increased mortality. Spinal cord injury, GCS score, AIS score, and ISS were significantly associated with 30-day and 1-year mortality however, Cox modeling was not significant for any variable. Kaplan-Meier analysis did not demonstrate a survival advantage for either management strategy. Nonoperative and operative mortality rates were not significant at any time point (12% vs 18%, p = 0.5 27% vs 24%, p = 0.8 and 41% vs 41%, p = 1.0 ). Overall mortality was 13% in-hospital, 26% at 30 days, and 41% at 1 year. The mean time to death or last follow-up was 22 months (range 0-129 months) and was nonsignificant between operative and nonoperative groups (p = 0.3). Additional cervical fracture, spinal cord injury, GCS score, AIS score, and ISS were not associated with either management strategy at the time of presentation. The mean age was 87 years (range 80-104 years). Mortality data were available for 100% of patients. RESULTS A total of 111 patients met inclusion criteria (94 nonoperative and 17 operative ). Statistical tests included the Student t-test, chi-square test, Fisher's exact test, Kaplan-Meier test, and Cox proportional hazard. Primary end points were mortality at 30 days and at 1 year. Prospectively recorded outcomes included Glasgow Coma Scale (GCS) score, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), additional cervical fracture, and cord injury. Cervical CT images were independently reviewed by blinded neurosurgeons to confirm a Type II fracture pattern. METHODS A single-center prospectively maintained trauma database was reviewed using ICD-9 codes to identify octogenarians with C-2 cervical fractures between 19. The authors compared operative and nonoperative management in patients older than 79 years. Previous studies have demonstrated a survival advantage following early surgery among patients older than 65 years, yet octogenarians represent a medically distinct and rapidly growing population. OBJECTIVE Type II odontoid fracture is a common injury among elderly patients, particularly given their predisposition toward low-energy falls.
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