11/9/2023 0 Comments Odontoid fracture type 2![]() The same differences in the nonunion rate and mortality rate were only observed in patients aged <70 years. We subdivided the patients according to age and compared the 2 therapeutic strategies in every subgroup. Regarding the primary outcomes, the nonunion rate was significantly lower in the operative group, consistent with the report by Di Paolo et al showing that patients undergoing surgery had a higher rate of fusion (91.6% vs 46.6%, statistically significant: P 50%. The data in which we were interested were the nonunion rate, mortality rate, complications, patient satisfaction, and the hospital stay, which were divided into primary and secondary outcomes. Eighteen studies were selected from 1630 potential articles by 2 authors. We searched 4 main databases to identify as many articles that met our criteria as possible. Moreover, type II odontoid fractures were also discussed individually, because they are the most frequent fracture type occurring in the geriatric population. The purpose of the subgroup analyses was to explore the sources of heterogeneity and compare the clinical effects between different surgical approaches and different age groups. Funnel plots were constructed to screen for potential publication bias. Sensitivity analyses were performed for high-quality studies. Statistical significance was set to P 50%), otherwise, the fixed-effects model was applied. Dichotomous outcomes are presented as odds ratios (ORs) with 95% CIs. Continuous outcomes are reported as weighted mean differences (WMDs) and respective 95% confidence intervals (CIs). Relevant data were extracted from the included studies and input into Cochrane RevMan 5.1 software for the meta-analysis. Therefore, the objective of this meta-analysis is to summarize and compare the outcomes of surgical and conservative treatments for type II and type III odontoid fractures in the elderly, focusing primarily on the nonunion rate and mortality rate, and secondarily on patient satisfaction, complications, and the hospital stay. In older patients, the achievement of this balance is even more challenging. Therefore, the identification of the proper balance between fracture healing and treatment complications is difficult. In addition, many patients complain about this treatment due to the long period of bed rest and the deterioration of the cervical spine anatomy. Nevertheless, many studies have revealed a lower union rate and higher mortality rate for nonsurgical methods. On the contray, conservative treatment is also divided into many groups, and the most common treatment is the “Halo-Vest.” Surgeons and patients both consider that conservative treatment decreases the hospital cost, the occurrence of complications, and relevant surgical risks. In particular, a surgical intervention poses significant risks to the very old population (>80 years of age). However, the condition of the patient may deteriorate after surgery. A surgical intervention results in a higher union rate. The posterior approach includes posterior wire/cable bone techniques and rigid segmental techniques (C1-C2 transarticular screws and segmental fixation into the laminae, pars, or pedicles of the axis and lateral mass screw fixation into the atlas). Surgical methods are classified into 2 main groups according to the approach. Type III fracture lines extend into the body of the axis. Type II fractures occur at the base of the odontoid process. Type I fractures involve avulsion near the tip of the dens. The Anderson and D’Alonzo classification of odontoid fractures. It is unclear whether conservative management (external stabilization) or surgical treatment is more suitable for treating unstable odontoid fractures moreover, there is no consensus on the particular surgical method. These adverse effects are observed in the elderly population, as unstable type II and type III odontoid fractures create a challenging physiologic problem for healing due to the combination of osteoporotic bone, a watershed area for the blood supply, and a high-strain location, among other problems. The optimal treatment for type II and type III geriatric odontoid fractures has been the topic of a substantial number of studies in recent years due to its predisposition toward displacement and nonunion. Type I fractures at the tip of the odontoid are rare and usually stable, type II fractures at the base of the odontoid process are the most common and are inherently unstable, and type III fractures occur through the body of the odontoid process and can be unstable. Odontoid fractures are classified into 3 main categories (Fig. In the elderly, odontoid fractures are the most common cervical spine fractures. More than 60% of spinal injuries involve the cervical spine, and approximately 25% of cervical spine injuries affect the axis. ![]()
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