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Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment.

Methods

Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson–D’Alonzo and Roy–Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation.

Results

Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment.

Conclusions

Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.

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Acknowledgements

The authors would like to thank the French Society of Spine Surgery (SFCR) for funding the online database (KEOPS) license and the methodological support provided by the Pôle IMER (Lyon, France).

Funding

The French Society of Spine Surgery (SFCR) funded the online database (KEOPS) license and the methodological support.

Author information

Authors and Affiliations

  1. Service de chirurgie du rachis, Hôpitaux Universitaires de Strasbourg, 1 place de l’Hôpital, BP 426, 67091, Strasbourg Cedex, France

    Yann Philippe Charles & Yves Ntilikina

  2. Unité de chirurgie du rachis, Université Aix-Marseille, CHU Timone, 264 rue Saint-Pierre, 13005, Marseille, France

    Benjamin Blondel & Stéphane Fuentes

  3. Unité de Chirurgie Rachidienne, Institut Universitaire de l’appareil Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06001, Nice, France

    Jérémy Allia & Nicolas Bronsard

  4. Service de neurochirurgie, CHU de Dijon, 14 rue Paul Gaffarel, 21000, Dijon Cedex, France

    Maxime Lleu

  5. Département de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700, La Tronche, France

    Benjamin Nicot

  6. Unité d’orthopédie-traumatologie rachis I, Hôpital Tripode, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076, Bordeaux cedex, France

    Vincent Challier

  7. Service de neurochirurgie, Hôpital Jean-Minjoz, 3 boulevard A Fleming, 25030, Besançon Cedex, France

    Joël Godard

  8. Service d’orthopédie-traumatologie, CHU de Nîmes, avenue du Pr Debré, 30000, Nîmes, France

    Pascal Kouyoumdjian

  9. Service de neurochirurgie, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France

    Nicolas Lonjon

  10. Service de neurochirurgie, Hôpital Roger-Salengro, CHRU de Lille, rue Emile-Laine, 59037, Lille, France

    Paulo Marinho

  11. Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon Cedex 03, France

    Julien Berthiller

  12. Service de neurochirurgie C et chirurgie du rachis, Hôpital P Wertheimer, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 59 boulevard Pinel, 69003, Lyon, France

    Eurico Freitas & Cédric Barrey

Authors
  1. Yann Philippe Charles
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  2. Yves Ntilikina
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  3. Benjamin Blondel
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  7. Maxime Lleu
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  8. Benjamin Nicot
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  9. Vincent Challier
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  12. Nicolas Lonjon
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  13. Paulo Marinho
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  14. Julien Berthiller
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  15. Eurico Freitas
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Corresponding author

Correspondence to Yann Philippe Charles.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval (Reference FC 2018-28) was obtained for this observational study.

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Charles, Y.P., Ntilikina, Y., Blondel, B. et al. Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases. Arch Orthop Trauma Surg 139, 43–51 (2019). https://doi.org/10.1007/s00402-018-3050-6

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  • DOI: https://doi.org/10.1007/s00402-018-3050-6

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