2 This fracture type is potentially serious due to the proximity of the medulla oblongata and. 1 In the elderly population, this fracture type represents the most common cervical spine fracture and in the population older than 80 years, the most common spine fracture of all. The high levels of morbidity and mortality associated with odontoid fractures should encourage all providers to pursue medical co-management and optimization of bone health following diagnosis. Odontoid fractures are widely common and reported to account for up to 15 of all cervical spine injuries. If operative management is chosen, a posterior approach is should be chosen when fracture- or patient-related factors make an anterior approach challenging. On the propensity scorematched analyses, the group that underwent surgery showed significantly better outcomes than the nonoperative group: Lower rate of fracture nonunion39.7 vs. In a frail elderly patient, a fibrous nonunion with close follow-up is an acceptable outcome. However, the risks of surgery in an elderly population must be carefully considered on a case-by-case basis. Type II fractures with any additonal risk factors for nonunion (displacement, comminution, etc) should be considered for surgical management. We believe that type I and type III odontoid fractures can be managed in a collar in most cases. A treatment algorithm is presented based on the available literature. The merits of operative vs nonoperative management, fibrous union, and the choice of operative approach in elderly patients are discussed. Keywords: anatomy atlantoaxial dislocation. We provide a review of the existing literature and discuss the classification and evaluation of odontoid fractures. Odontoid Fractures are relatively common fractures of the C2 (axis) dens that can be seen in low energy falls in elderly patients and high energy traumatic injuries in younger patients. recognize this pathology and to distinguish os odontoideum from odontoid fractures in trauma patients. Poor bone health and medical comorbidities contribute to increased surgical risk in this population however, nonoperative management is associated with a risk of nonunion or fibrous union. Despite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. Treatment may take the form of surgery or wearing a brace. Type III: A fracture occurring in the body of the axis underlying the dens. A tunnel was made using a curved curette into the C2 vertebral body until the cranial fragment of the odontoid was reached. Type I: A fracture of the upper part of the process (the tip.) Type II: A Fracture at the base of the dens. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. There are varied management approaches with paucity of robust evidence to guide decision-making. Odontoid fractures are the most common fracture of the axis and the most common cervical spine fracture in patients over 65. Partial corpectomy of the anterosuperior corner of C3 was done, then a square awl was inserted in the anterior side of the inferior endplate of C2. Odontoid fractures constitute the commonest cervical spinal fracture in the elderly.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |