Early Morbidity and Mortality Associated With Elderly Odontoid Fractures

Odontoid fracture treatment is well documented, but challenges remain in treating these fractures in elderly patients. Issues include identifying the optimal treatment for bony union, determining the stability of a nonunion, and understanding the long-term consequences of nonunion. In elderly patients, the focus tends to shift to morbidity and mortality. This retrospective review describes the early morbidity and mortality in the authors' elderly odontoid fracture population. The authors reviewed the medical records, radiographs, and death certificates of 37 patients aged 65 years or older who were diagnosed with type 2 odontoid fractures between 1994 and 2004. Average follow-up was 28.7 +/- 32.5 weeks (range, 0-133 weeks). More than three-fourths of the patients were injured in a fall. All of the odontoid fractures were type 2. The 3 most common comorbidities were hypertension, heart disease, and rheumatoid arthritis. The majority of patients were treated nonoperatively with a collar or halo. Six patients experienced 1 procedure-related complication. Overall, 18 (48.6%) of 37 patients experienced complications, including 3 (8.15%) deaths. In elderly patients with odontoid fractures, one should be prepared for a hospital course complicated by medical issues; early mortality rates are significant. These issues appear to exist regardless of the fracture treatment chosen; one must anticipate respiratory, swallowing, balance, and cardiac problems. Management strategies should be individualized to the patients; operative and nonoperative treatments remain viable options.