11/23/2023 0 Comments Odontoid fracture type 2![]() By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group. A minimum of 16 patients are needed in each group to test the superiority with 80% power. The minimal clinically important difference of the NDI is 3.5 points. Excluded are patients with an American Society of Anaesthesiologists (ASA) score ≥ 4, dementia nursing care or anatomical cervical anomalies. Fifty consecutive patients aged ≥ 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical superiority of the surgical treatment of type-2 odontoid fractures, with a 1-year Neck Disability Index (NDI) as the primary endpoint. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon. Tech.Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1-C2 fusion. Elliott RE, Tanweer O, Boah A, et al (2014) Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs: Meta-analysis and review of literature.Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation.Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation.Riley DS, Barber MS, Kienle GS, et al (2017) CARE guidelines for case reports: explanation and elaboration document.Klimov V, Kosimshoev M, Evsyukov A, et al (2020) Surgical treatment of neglected C2 odontoid process fracture with anterior atlantoaxial dislocation.Aggarwal RA, Rathod AK, Chaudhary KS (2016) Irreducible atlanto-axial dislocation in neglected odontoid fracture treated with single stage anterior release and posterior instrumented fusion.Butler JS, Dolan RT, Burbridge M, et al (2010) The long-term functional outcome of type II odontoid fractures managed non-operatively.Chapman J, Smith JS, Kopjar B, et al (2013) The AOSpine North America geriatric odontoid fracture mortality study: A retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up.Iyer S, Hurlbert RJ, Albert TJ (2018) Management of odontoid fractures in the elderly: A review of the literature and an evidence-based treatment algorithm.We were convinced that the C1-C2 right articulation was completely fused in a wrong alignment, and this new exam helped us understanding the real dynamic condition of the upper cervical column and choosing the approach considering more elements. We found extremely useful the execution of a CT scan in both head-neck flexion and extension. These considerations and the higher confidence we have in performing a Goel-Harms fixation, led us to choose this kind of technique. The main reason was that the fracture happened 18 months earlier, and in CT scan it is clearly noticeable the sclerosis in the odontoid fracture margins, which can lead to extreme technical difficulties in placing an odontoid screw and it is associated with high rate of non-union.Įven though some surgeons prefer a trans-articular (TAS) technique in older age group for C1-C2 fixation, some authors found a higher incidence of vertebral artery injury and misplaced screws and a slightly lower rate of fusion with the TAS technique. We excluded the possibility to perform a trans-odontoid screw fixation, despite the favourable fracture line orientation. We want to briefly discuss the factors that led us to perform a Goel-Harms fixation. Angio-CT scan showed good perfusion of both vertebral arteries. No ossifications of alar or transverse ligaments were noticed. A cervical MRI was performed, showing no compression on the neural elements. The overall bone density of cervical bone structures was normal. She underwent a cervical CT scan ( Figure 1) showing Anderson type II odontoid fracture with severe atlanto-axial anterior dislocation and fusion signs in the right C1-C2 articulation. ![]() No comorbidities were referred, apart hypertension under treatment. The physical examination was normal, except for neck pain, rated 6/10 in Visual Analogue Scale. She did not remember which vertebra was involved and had not any documentation, since she was in a foreign hospital at the time and was discharged without receiving any prescription of treatment. She had a car accident 18 months earlier, after which a cervical fracture was diagnosed. A 60-year-old woman came to our Emergency Department complaining of worsening neck pain in the last 6 months.
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