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Odontoid fractures in combination with C1 fractures in the elderly treated by combined anterior odontoid and transarticular C1/2 screw fixation

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

Abstract

Introduction

The purpose of this study was to evaluate risk factors of accompanied C1 fractures in elderly patients with type II odontoid fractures (OF) and to analyze the complication rate and the outcomes of patients after combined anterior odontoid and transarticular C1/2 screw fixation (AOTAF).

Materials and methods

The study represents a retrospective case series at a single level-1 trauma center. All elderly patients (≥ 70 years) with acute combination injuries (CI) including type II OF with an accompanied C1 fracture, who were treated by an anterior approach, were included. All postoperative complications were analyzed based on the patient notes. Clinical and radiological controls were performed after 1 year. Main parameters of interest were 1-year mortality rate, pain level, and satisfaction rate after 1 year.

Results

A total of 23 patients were included. The average age was 84.6 years (range 73–94 years). All patients had atlanto-odontoid osteoarthritis (AOO) and all but two patients were injured by low-energy falls. Dysphagia was the most common postoperative complication (26.1%). Surgical revision was necessary in one of these patients due to hematoma. Dysphagia improved in all patients considerably. Loss of follow-up was 21.7%. The 1-year mortality was 21.7% (n = 5). The mean pain level and satisfaction rate was 2.5 (± 0.9) and 7.3 (± 0.7), respectively. After 1 year, no signs of non-union were visible.

Conclusions

AOO was observed in all patients with CI. The main cause of trauma was a low-energy fall. The pain levels were low to moderate and satisfaction levels were promising 1 year after surgery. Nonetheless, AOTAF is associated with a high rate of postoperative dysphagia, which resolves in the majority of patients due to conservative management.

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Acknowledgements

The authors are thankful to Jocelyn Todd for her proof reading.

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Author notes

  1. Christoph Josten and Jan-Sven Jarvers contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany

    Christoph Josten, Jan-Sven Jarvers, Stefan Glasmacher & Ulrich J. Spiegl

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  1. Christoph Josten
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  2. Jan-Sven Jarvers
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  3. Stefan Glasmacher
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  4. Ulrich J. Spiegl
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Correspondence to Ulrich J. Spiegl.

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Josten, C., Jarvers, JS., Glasmacher, S. et al. Odontoid fractures in combination with C1 fractures in the elderly treated by combined anterior odontoid and transarticular C1/2 screw fixation. Arch Orthop Trauma Surg 138, 1525–1531 (2018). https://doi.org/10.1007/s00402-018-3013-y

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  • DOI: https://doi.org/10.1007/s00402-018-3013-y

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