Investigators found elderly patients who had odontoid type II fractures experienced frailty comparable to that of patients with hip fracture and had significant rates of mortality and morbidity, according to a study that was one of two Gold Free Papers Award winners for Trauma at the 18th EFORT Annual Congress in Vienna.
“This was a retrospective analysis of prospectively collected data,” study investigator Hassaan Q. Sheikh, MRCS, of the department of trauma and orthopaedics, Leeds General Infirmary, told Orthopaedics Today Europe. “We investigated the clinical outcome, as well as the morbidity and mortality rates, following a type II odontoid peg fracture, which is a common low-energy fracture of the cervical spine in the elderly.”
Researchers identified 101 consecutive patients referred to a U.K. teaching hospital with a type II odontoid peg fracture during a 6-year period. Age younger than 65 years was the sole exclusion criterion. All patient images were reviewed, and patient demographics and comorbidities at the time of referral were extracted from hospital databases and case notes. Data were collected on treatment of the injury, other injuries, neurological status, date of death and cause of death. To assist with interpretation, the researchers coded concomitant injuries by injury severity score (ISS). Comorbidity was likewise coded to calculate Charlson comorbidity index score. The researchers evaluated all clinic follow-up visits, neurologic injuries and other complications. Sequential univariate analysis and multivariate Cox regression analysis were used to identify risk factors linked to early mortality.
Operative treatment for displacement
Of 101 patients identified for analysis, 91 were treated nonoperatively through cervical orthotic intervention and 10 underwent surgical intervention. Of those treated surgically, two underwent halo fixation followed by occipitocervical fusion and eight underwent primary occipitocervical fusion. The reasons for an operative intervention included significant displacement, pathological fractures and neurological deficit.
Four patients had neurological disability subsequent to injury, including central cord syndrome and Brown-Séquard syndrome.
The researchers found that at 30 days, the mortality rate was 9.9%. At 90 days, the mortality rate was 15.8%.
“Commonest causes of mortality included pneumonia, acute coronary syndrome and malignancy,” Sheikh said. “The only risk factor positively attributable to early mortality was advancing age. Of the patient cohort, 90% were treated nonoperatively in a rigid color, whilst the rest were treated operatively,” he said.
Mortality and increased Charlson score
Nonsignificant associations were seen between early mortality and increasing Charlson score and ISS.
“The drive for this study was the similarity in patient demographics between hip fracture patients and those with odontoid peg fractures. Since an odontoid peg fracture injury is less common than a hip fracture, it gets less attention at a national level and therefore attracts less funding. Hip fractures have rightly been given more recognition due to their high rate of mortality and morbidity,” Sheikh said. “We wanted to investigate and show that the patient population with odontoid peg fractures is just as frail as hip fracture patients and have similar levels of morbidity and mortality.”
Sheikh said these findings underscore the importance of multidisciplinary cooperation in the treatment of patients with odontoid peg fractures.
“These patients are currently admitted under orthopaedic surgical teams with little or no regular input from physicians,” he said. “However, it has been shown in England that by integrating hip fracture care between surgeons and physicians, morbidity and mortality can be reduced. We argue the same should be applied for the odontoid peg fracture population.” – by Jennifer Byrne
- Sheikh HQ, et al. Paper #22. Presented at 18th EFORT Annual Congress; 31 May - 2 June 2017; Vienna.
- For more information:
- Hassaan Q. Sheikh, MRCS, can be reached at Leeds General Infirmary, 10 Oldroyd Way, Dewsbury, Wakefield 13 2JJ, United Kingdom; email: firstname.lastname@example.org.
Disclosure: Sheikh reports no relevant financial disclosures.