Discuss the components of proper evaluation and assessment of a patient presenting with a potential odontoid process fracture, including any indicated imaging studies.Describe the unique vertebral anatomy of the second cervical vertebra (axis), including the odontoid process.This activity reviews the etiology, presentation, evaluation, and management of fractures of the C2 dens and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition. The most common mechanism of injury is a hyperextension of the cervical spine, pushing the head and C1 vertebrae backward. Fracture of the odontoid process is classified into one of three types, which are type I, type II, or type III fractures, depending on the location and morphology of the fracture. The first cervical vertebrae (atlas) rotates around the odontoid process to provide the largest single component of lateral rotation of the cervical spine. Δ OTA Grant.The odontoid process, or dens, is a superior projecting bony element from the second cervical vertebrae (C2, or the axis). ◆FDA information not available at time of printing. The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use).Factors without statistical significance included age, BMI, tobacco use, sagittal fracture displacement, direction of displacement, type of odontoid fracture, odontoid angle, time to surgery, method of nonsurgical management, time to discontinuation of rigid collar, and surgical technique.Ĭonclusion: Factors associated with nonunion in older patients with odontoid fractures include: nonsurgical treatment, males, higher numbers of medical comorbidities, and congestive 52 patients were found to have a fusion of their odontoid fracture, and only 4 of those patients had CHF (7.7%) (χ2 = 0.002). Out of the 21 patients who were found to have nonunion, 8 (38.1%) had a diagnosis of CHF at the time of admission. Additionally, congestive heart failure (CHF) was a significant independent medical comorbidity associated with nonunion. Those with fusion had a lower Charlson score (1.65) than those who did not fuse (2.67) (t = –2.045, sig = 0.045). Patients treated with nonsurgical management had a lower rate of fusion (31 of 51, 60.8%) compared to patients who were treated with surgery (21 of 22, 95.5%) (χ2 = 0.003). The overall fusion rate in the 73 patients who were living at the time of fusion analysis was 71.2%. Results: There were 31 males (42%) and 42 females with a mean age of 80 (range, 65-93) who were evaluated for fusion of their type 2 (55, 75%) or 3 (18, 25%) odontoid fracture. One patient was lost to follow-up prior to evaluation for fusion. 23 mortalities occurred prior to 6 months postinjury, and they were excluded from the fusion analysis. Radiographs were reviewed and fusion was determined by flexion/extension x-rays, CT scan, or both. Methods: Between 20, 97 consecutive patients, age 65 years and over, with type 2 and type 3 odontoid fractures were treated at a single Level I trauma center, were followed in a single private practice, and retrospectively evaluated. The purpose of this study was to determine factors that were associated with nonunion in odontoid fractures. Purpose: Odontoid fractures are the most common cervical spine injury in older adults and have high rates of morbidity and mortality. Stubbart, MD 2,3 ġ Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA Ģ Orthopaedic Associates of Michigan, Grand Rapids, Michigan, USA ģ Michigan State University, Grand Rapids, Michigan, USA Sietsema, PhD 2,3 Casey Smith, MD 1 Tan Chen, BS 3 Factors Associated With Nonunion in 97 Consecutive Type 2 and Type 3 Odontoid Fractures in Elderly Patientsįri., 10/11/13 Pediatrics/Spine, PAPER #74, 4:36 pm OTA 2013
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