![]() Type III odontoid fractures in the elderly optimal treatment with a strong recommendation is immobilization in a hard collar. Type II fractures in this population are recommended to be treated operatively with a weak recommendation, and if treated nonoperatively using a hard collar immobilization device. The odontoid process and atlas were dislocated to an extreme posterior and right position (Fig. Excluded are patients with an American Society of Anaesthesiologists (ASA) score 4, dementia nursing care or anatomical cervical anomalies. Cervical CT scan and 3-D reconstruction digital anatomy confirmed an odontoid fracture associated with a partial cortical avulsion fracture of the anterior tubercle of the atlas. Odontoid fractures have a significant morbidity in the elderly (>65 years) population. Fifty consecutive patients aged 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. It can be associated with atlantoaxial instability. These abstracts where then reviewed in detail and 117 manuscripts were selected, which were obtained and supplemented with additional manuscripts to form an evidentiary table. Odontoid fractures occur as a result of trauma to the cervical spine. Os odontoideum (plural: ossa odontoidea) is an anatomic variant of the odontoid process of C2 and needs to be differentiated from persistent ossiculum terminale and from a type 2 odontoid fracture. The subsequent search resulted in a return of 377 manuscripts. The MEDLINE search engine returned 1759 articles, which were further limited to "all aged (65 and over)," human subjects and the English language. The literature searches revealed low and very low quality evidence with no prospective or randomized studies. These treatment recommendations were then rated as either strong or weak based on the quality of evidence and clinical expertise. Plain radiographs, when they show the lateral projection of the cervical spine and include an open mouth view, are fairly sensitive in identifying c-spine. Using the GRADE evidence-based review system, the proposed questions were answered using the literature review and expert opinion. The odontoid process, or dens, is a superior projecting bony element from the second cervical vertebrae (C2, or the axis). The quality of literature was rated as high, moderate, low, or very low. MeSH keywords were searched through MEDLINE, EMBASE, and the Cochrane Database of Systematic reviews, and pertinent abstracts and manuscripts obtained. was possible to partially reduce the subluxation. However, these articles are of low quality and optimal treatment algorithms do not exist.įocused questions on the treatment of elderly patients with Type II and III odontoid fractures were refined by a panel of spine traumologists surgeons, consisting of fellowship trained neurologic and orthopedic surgeons. reatment of fractures of the odontoid process of the axis (the dens) has the potential to. Numerous manuscripts have been written about treatment strategies of odontoid fractures in the elderly. To define optimal clinical care for elderly patients with Type II and III odontoid fractures using a systematic review with expert opinion.
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