The searches were performed using medical subject heading terms and the subheadings used were Fracture, Odontoid, type-2, operative, management, nonoperative. Īim of present study is to evaluate literature and find out the strategy which can be adopted in managing type-2 odontoid fracture in elderly until evidence based protocol or standard guideline can be established.Ī systematic computerized literature search was performed using PubMed, Google Scholar databases. Surgeon with experiences in this field knows that surgical outcome can as easily be adverse as it can be beneficial. The treatment of odontoid fracture in the elderly requires surgeons to balance considering patients’ medical comorbidities and surgical morbidity and mortality against the high rate of nonunion occurring with conservative management. The incidence of odontoid fractures is likely to increase in future throughout the world as longevity of people is increasing. ![]() In most countries of the world, the elderly are the most rapidly growing segment of society and it is estimated that by 2025 almost a fifth of the population will be over the age of 65. In elderly people, poor bone health and medical co-morbidities contribute to increased surgical risk, however, nonoperative management is associated with risk of complications like nonunion or fibrous union. ĭespite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. Decreased BMD is a major predisposing factor for the occurrence of traumatic osteoporotic fractures in the elderly. ![]() Besides degenerative changes, odontoid fractures in the elderly seem to be an osteoporotic fracture and the poor outcome is also contributed by higher rate of communition at the fracture site. Because of age related comorbidities and ubiquitous presence of degenerative changes in the aging cervical spine, elderly patients are at higher risk for complications and poorer outcomes than younger patients sustaining similar injuries. Elderly patients with type-2 odontoid fracture are also associated with a high rate of mortality, regardless of intervention. While there is no consensus on why these fractures are difficult to heal, hypotheses include vascular insult, odontoid morphology and ligamentous forces. Several other authors have also reported a high rate of nonunion in type-2 fractures. Type-2 odontoid fractures have been associated with limited healing potential, as the original report by Anderson and D’Alonzo. In contrast to younger age group, elderly patients had predominantly type-2 fractures. The mechanism responsible for odontoid fracture is generally accepted to be hyper-flexion or hyper-extension of cervical spine. In young adults, the fractures occur most often due to high energy trauma including motor vehicle crashes and in the elderly with low energy trauma commonly due to fall from standing height. Odointoid fracture has a bimodal distribution involving early childhood and the elderly age group. They represent the most common cervical spine injury of patient older than 70 years. Odontoid fracture accounts for approximately 15% - 20% of all fractures of cervical spine. Surgical treatment is associated with little advantage but should be selected with proper attention to age, comorbidities, fracture geometry and it is better to individualize the treatment strategy. Conservative treatment of this fracture in the elderly should preferably be carried out with hard collar or avoiding halo vest. Though surgical treatment has a better outcome, it is also limited by the co-mobidities and hazards of anesthesia and surgery in elderly patients. Current studies suggest that surgical management of odontoid fractures may offer a protective benefit but it is limited to patients younger than 75 years of age. When conservative treatment of this fractures is indicated that should be carried out with hard cervical collar or cervicothoracic orthosis. ![]() Nonoperative treatment with halo vest is associated with very high rate of complication in elderly patient. Objective of this review is to find a controversial aspect of management along with opinion to find out a standard guideline by searching the literature in Pubmed and Google scholar databases with key words : odontoid, fracture, type-2, management, nonoperative and operative management. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 odontoid fractures still ha s some controversial issues. This injury is associated with a high incidence of morbidity, mortality and nonunion in the elderly irrespective of mode of treatment. Among the odontoid fracture, type-2 fracture is the most common variety. Odontoid fracture accounts for 15% - 20% of all cervical spine injuries.
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