Medical Student University of New England College of Osteopathic Medicine Biddeford, Maine, United States
Disclosure(s):
James R. Withers: No financial relationships to disclose
Introduction: Odontoid fractures are common in the elderly population and optimal management is often debated. The present study aims to describe our experience with non-operative management of patients with fibrous nonunion of type II odontoid fractures, defined as non-unions without instability on dynamic imaging with anatomic or near-anatomic alignment.
Methods: A RedCap database was created by searching the EPIC electronic medical record for odontoid fractures at a single level 1 trauma center between the years 2015-2022. Demographic, radiologic, and clinical data were collected, and cases were sorted based on fracture morphology and outcome. The type II odontoid fracture outcomes were divided into three categories: those that fused with non-operative care; those that underwent surgical stabilization; or those which went on to fibrous non-union. The outcomes for patients managed non-operatively with fibrous non-union were examined.
Results: 132 patients with odontoid fractures were identified and 31 underwent surgery. Of the remaining 101 patients managed conservatively initially, 44 achieved solid union, 30 went on to fibrous non-union managed non-operatively, 15 died before follow-up, and 12 were lost to follow-up. Of the 30 fibrous non-union patients that were managed nonoperatively, the average age was 86.2 years, 18 presented with acute fractures, 12 with chronic fractures, and 15 died during the study period. The average age of the 15 fibrous non-union patients that died was 87.9 years with a mean survival of 15.4 months ranging from 15 to 47.2 months, and none died from spinal cord injury. The causes of death were heart failure in 8/15 and 7/15 died of gastrointestinal-related, cancer, renal failure, sepsis, stroke, or respiratory causes.
Conclusion : Fibrous non-union of odontoid fracture appears to be a safe outcome in carefully selected elderly patients with odontoid fracture. No neurological events or mortalities were identified, and the mean survival was beyond one year.
