In the Journals

Aggressive management of acute odontoid fractures may be warranted

According to the findings of a recently published study, patients with acute odontoid fractures and severe atlantoaxial instability may be at a higher risk of nonunion and mortality, potentially warranting the use of more aggressive management.

One hundred twenty-four patients with odontoid fractures were analyzed retrospectively, with two independent blinded reviewers measuring atlantoaxial instability (AAI) using post-injury CT scans. Patients’ AAI was classified as either “severe” or “minimal,” determined by the mean subluxation across each C1-2 facet joint being greater than, less than or equal to 50%. The researchers also used independent samples t tests to compare rates of mortality and nonunion, adjusting for age, displacement and subtype through the use of binary logistic regression. Mean follow-up was 4.4 months.

After analyzing the cohort, 107 patients were classified as having minimal AAI and 17 patients were classified as having severe AAI. According to the researchers, patients with severe AAI were more likely to experience nonunion (29% vs. 10%, respectively) and mortality (35% vs. 14%, respectively) regardless of treatment. Additionally, when adjusted for age, mortality risk increased twofold in severe AAI patients, and by threefold when patients had type II fractures.

The researchers concluded the increased risks of nonunion and mortality for patients with odontoid fractures and severe AAI should help guide patients and surgeons when considering surgery or nonsurgical options to treat the injury. – by Robert Linnehan

Disclosures: Evaniew reported no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

According to the findings of a recently published study, patients with acute odontoid fractures and severe atlantoaxial instability may be at a higher risk of nonunion and mortality, potentially warranting the use of more aggressive management.

One hundred twenty-four patients with odontoid fractures were analyzed retrospectively, with two independent blinded reviewers measuring atlantoaxial instability (AAI) using post-injury CT scans. Patients’ AAI was classified as either “severe” or “minimal,” determined by the mean subluxation across each C1-2 facet joint being greater than, less than or equal to 50%. The researchers also used independent samples t tests to compare rates of mortality and nonunion, adjusting for age, displacement and subtype through the use of binary logistic regression. Mean follow-up was 4.4 months.

After analyzing the cohort, 107 patients were classified as having minimal AAI and 17 patients were classified as having severe AAI. According to the researchers, patients with severe AAI were more likely to experience nonunion (29% vs. 10%, respectively) and mortality (35% vs. 14%, respectively) regardless of treatment. Additionally, when adjusted for age, mortality risk increased twofold in severe AAI patients, and by threefold when patients had type II fractures.

The researchers concluded the increased risks of nonunion and mortality for patients with odontoid fractures and severe AAI should help guide patients and surgeons when considering surgery or nonsurgical options to treat the injury. – by Robert Linnehan

Disclosures: Evaniew reported no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.