Type II fractures in this population are recommended to be treated operatively with a weak recommendation, and if treated nonoperatively using a hard collar immobilization device. Odontoid fractures have a significant morbidity in the elderly (>65 years) population. Traumatic atlantoaxial dislocation without fracture of the odontoid. These abstracts where then reviewed in detail and 117 manuscripts were selected, which were obtained and supplemented with additional manuscripts to form an evidentiary table. Odontoid fractures occur as a result of trauma to the cervical spine. Compared with laminectomy and occipitocervical fusion, it retains partial range of. The subsequent search resulted in a return of 377 manuscripts. Harrop, in Schmidek and Sweet Operative Neurosurgical Techniques (Sixth Edition), 2012 Odontoid Fracture. The MEDLINE search engine returned 1759 articles, which were further limited to "all aged (65 and over)," human subjects and the English language. The literature searches revealed low and very low quality evidence with no prospective or randomized studies. These treatment recommendations were then rated as either strong or weak based on the quality of evidence and clinical expertise. after 3 months, the patient is symptom free, with partial bone fusion. Using the GRADE evidence-based review system, the proposed questions were answered using the literature review and expert opinion. The cervical CT scan revealed a particular type of odontoid fracture, unframeable. Irreducible unstable odontoid fractures are more common in young patients with high-impact and high-velocity trauma when strong disruptive forces act upon the osseoligamentous complex at the base of the skull. The quality of literature was rated as high, moderate, low, or very low. Fracture displacement and irreducibility is multifactorial following odontoid trauma. Type I fractures occur very rarely and type II is the most common Type I: avulsion fracture of the apex. This is called the Anderson and D’Alonzo classification. MeSH keywords were searched through MEDLINE, EMBASE, and the Cochrane Database of Systematic reviews, and pertinent abstracts and manuscripts obtained. There are three different types of odontoid process fracture characterised by the anatomic location of the fracture line. However, these articles are of low quality and optimal treatment algorithms do not exist.įocused questions on the treatment of elderly patients with Type II and III odontoid fractures were refined by a panel of spine traumologists surgeons, consisting of fellowship trained neurologic and orthopedic surgeons. Numerous manuscripts have been written about treatment strategies of odontoid fractures in the elderly. The patients had no neurological deficits in seven of the reported cases 1, 2, 3. In the last thirty years only fifteen clinical cases have been described 1, 2. To define optimal clinical care for elderly patients with Type II and III odontoid fractures using a systematic review with expert opinion. Introduction The combination of atlanto-axial joint dislocation and odontoid process fracture is usually a lethal injury and as a result, reports of survivors are rare.
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