![]() The percentage of patients discharged to a skilled nursing facility was similar among all three groups. However, there were significantly less DVTs in the non-OP group compared with the early-OP group (2.9% vs. There was also no difference among all three groups with respect for the need for tracheostomy and PEG and the development of UTI or pneumonia. There was no statistically significant difference in mortality among the three groups (11.7% early-OP, 8.7% late-OP, and 17.6% non-OP). Injury Severity Score, number of preexisting conditions, mechanism of injury, and distribution of type of odontoid fractures were similar among all three groups. : The non-OP patients were significantly older than either operative group (mean, 82.4 for non-OP 77.4 for early-OP and 76.4 for late-OP p = 0.006 non-OP compared with either operative group). Differences among groups were tested using analysis of variance, Students t test, chi, and Fishers exact test. Outcomes evaluated included in-hospital mortality, ventilator days, hospital length of stay (HLOS), need for tracheostomy and percutaneous endoscopic gastrostomy (PEG), and the complications of urinary tract infection (UTI), deep vein thrombosis (DVT), and pneumonia. Patient characteristics that were evaluated and compared among the three groups included age, Injury Severity Score, preexisting conditions, and the type of odontoid fracture. Patients were then grouped according to treatment, early-OP (3 days), or non-OP treatment. : The trauma registry of our level I trauma center was queried for elderly (age > or = 60) patients with odontoid fractures from January 2000 to May 2006. This study was undertaken in an attempt to develop management consensus by examining outcomes in elderly patients with odontoid fractures and comparing OP to a nonoperative (non-OP) approach. Within our own institution, treatment is variable depending largely on surgeon preference. There are conflicting data in the literature with regard to timing of operative fixation (OP), as well as whether OP should be performed. Type III fractures, which extend into the body of the axis through cancellous bone, are treated with closed reduction and halo immobilization.: Treatment of odontoid fractures remains controversial. Displaced fractures should be considered for operative treatment, either with atlantoaxial arthrodesis or anterior screw fixation. Nondisplaced fractures should be treated with halo immobilization for 8 to 12 weeks, with careful clinical and radiographic monitoring. These are the most common odontoid fractures and are associated with a high incidence of nonunion. Type II fractures occur at the junction of the odontoid process and the body of the axis. These rare injuries require only external immobilization with an orthosis if there is no associated ligamentous injury. Type I fractures are avulsion fractures of the tip of the odontoid process. Magnetic resonance imaging has been recommended for evaluating associated ligamentous injuries and may be helpful in detecting occult cervical spine fractures. Plain radiography, polytomography, and computed tomography are all useful in delineating the fracture pattern. ![]() Fracture displacement, compromised blood supply, comminution, and iatrogenic distraction have all been implicated in the reported high rates of nonunion. Fractures of the odontoid process are uncommon injuries.
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