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Axis Fractures in Elderly: Epidemiology and Treatment related outcome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.ORCID iD: 0000-0002-0705-033X
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Axis fractures are a common injury in the elderly population. Treatment is often complicated due to osteoporosis and patient comorbidity. Knowledge of the incidence of these fractures, as well as their treatment, outcome and mortality rate, will improve knowledge and decision-making processes for this fragile group of patients.

Objectives: This thesis aims (1) to review the literature on the non-surgical and surgical treatment of odontoid fractures type 2 in the elderly population, (2) to provide an updated overview of axis fracture subtypes, their incidence and their treatment in a cohort in two university cities, (3) to map the incidence of fractures and the treatment of these patients in Sweden, (4) to investigate the effect on mortality of both the surgical and non-surgical treatment of axis fractures and (5) to present the protocol for a randomized controlled trial (RCT) on the treatment of odontoid fractures type 2 in the elderly population.

Methods: A systematic review was performed using the MeSH keywords “odontoid AND fracture AND elderly”. The data for the cohort study were extracted from the regional hospital information system. The radiographs were reviewed retrospectively. Data were extracted from the Swedish National Patient Registry (NPR) and the mortality registry for the national registry studies. Finally, the RCT protocol was carried out according to the SPIRIT and CONSORT statements for clinical trial reporting.

Results and conclusions: So far, there has been a scarcity of existing evidence on treatment of odontoid fractures type 2 in the elderly population. In this thesis, we found in two university cities an increased incidence, and a trend towards more surgical treatment of type 2 and 3 odontoid fractures 2002-2014. Between 1997 and 2014 in Sweden, there was an increasing incidence of C2 fractures, but the treatment trend went towards more non-surgical treatment. Surgically treated patients had a greater survival rate than non-surgically treated patients. Among those over 88 years of age, surgical treatment lost its effect on survival. In the RCT we will study the function of patients with odontoid fractures type 2 and by comparing non-surgical treatment with posterior C1-C2 fusion, the cost-effectiveness of the treatment options.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. , p. 84
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1399
Keywords [en]
odontoid fracture, treatment, elderly, cervical spine, axis fracture
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-333901ISBN: 978-91-513-0163-1 (print)OAI: oai:DiVA.org:uu-333901DiVA, id: diva2:1159394
Public defence
2018-01-12, Gunnesalen, Ing 10, Psykiatrins hus, Sjukhusvägen, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-12-21 Created: 2017-11-22 Last updated: 2018-03-08
List of papers
1. Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly
Open this publication in new window or tab >>Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly
2014 (English)In: BioMed Research International, ISSN 2314-6133, Vol. 2014, p. 231948-Article, review/survey (Refereed) Published
Abstract [en]

Odontoid fractures type II according to Anderson and d’Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2014
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-218396 (URN)10.1155/2014/231948 (DOI)000331736300001 ()
Available from: 2014-02-11 Created: 2014-02-11 Last updated: 2018-01-11Bibliographically approved
2. C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases
Open this publication in new window or tab >>C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases
2017 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 8321680Article in journal (Refereed) Published
Abstract [en]

The currently available data on the distribution of C2 fracture subtypes is sparse. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. A dataset of all patients treated between 2002 and 2014 for C2 fractures was extracted from the regional hospital information system. C2 fractures were classified into odontoid fractures types 1, 2, and 3, Hangman's fractures types 1, 2, and 3, and atypical C2 fractures. 233 patients (female 51%, age 72 +/- 19 years) were treated for a C2 fracture. Odontoid fractures were found in 183 patients, of which 2 were type 1, 127 type 2, and 54 type 3, while 26 of C2 fractures were Hangman's fractures and 24 were atypical C2 fractures. In the geriatric subgroup 89% of all C2 fractures were odontoid, of which 71% were type 2 and 29% type 3. There was an increasing incidence of odontoid fractures types 2 and 3 from 2002 to 2014. 40% of C2 fractures were treated surgically. This study presents reliable subset proportions of C2 fractures in a prospectively collected regional cohort. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures.

Place, publisher, year, edition, pages
HINDAWI LTD, 2017
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-320489 (URN)10.1155/2017/8321680 (DOI)000394008200001 ()
Available from: 2017-04-20 Created: 2017-04-20 Last updated: 2018-01-13Bibliographically approved
3. Epidemiology of C2 Fractures in the 21st Century: A National Registry Cohort Study of 6,370 Patients from 1997 to 2014
Open this publication in new window or tab >>Epidemiology of C2 Fractures in the 21st Century: A National Registry Cohort Study of 6,370 Patients from 1997 to 2014
2017 (English)In: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, article id 6516893Article in journal (Refereed) Published
Abstract [en]

Objective. C2 fractures are a common injury in the elderly population. Treatment is often complicated due to osteoporosis and patient comorbidity. This study aims to investigate the incidence and treatment trend of C2 fractures in Sweden. Methods. Patients with the principal and secondary diagnosis of fracture of the second vertebrae (ICD-10: S12.1) between 1997 and 2014 were identified in the Swedish National Patient Registry (NPR). Results. Between 1997 and 2014, 6,370 patients with a C2 fracture (51% male; age: ) were identified in the NPR. The incidence of C2 fractures increased from 3 to 6 per 100,000 (; ), mainly due to an increase of incidence in the geriatric subgroup (≥70 years). The percentage of surgically treated patients decreased from 1997 to 2014 (; ). Younger age, male gender, spinal cord injury, and earlier year of admission were associated with surgical treatment assignment.Discussion. This study documents a rising incidence of C2 fractures in the elderly during the last two decades in Sweden. Greater awareness of fractures, improved diagnostics, coding, and a higher activity level of the patients are plausible causes. The declining trend of surgical treatment warrants further study.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2017
National Category
Orthopaedics
Research subject
Epidemiology; Orthopaedics
Identifiers
urn:nbn:se:uu:diva-332535 (URN)10.1155/2017/6516893 (DOI)000413430600001 ()
Available from: 2017-10-30 Created: 2017-10-30 Last updated: 2018-02-05Bibliographically approved
4. Surgical treatment improves survival of elderly with axis fracture: a national population-based multi-registry cohort study
Open this publication in new window or tab >>Surgical treatment improves survival of elderly with axis fracture: a national population-based multi-registry cohort study
(English)Manuscript (preprint) (Other academic)
Keywords
Axis fractures, odontoid fractures, surgical treatment, mortality, elderly, spinal fractures
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-333896 (URN)
Available from: 2017-11-18 Created: 2017-11-18 Last updated: 2018-01-13
5. Protocol for a multicentre randomised controlled trial on surgical versus non-surgical management of displaced odontoid fractures type 2 in patients aged ≥75 years: Uppsala Study on Odontoid Fracture Treatment (USOFT)
Open this publication in new window or tab >>Protocol for a multicentre randomised controlled trial on surgical versus non-surgical management of displaced odontoid fractures type 2 in patients aged ≥75 years: Uppsala Study on Odontoid Fracture Treatment (USOFT)
(English)Manuscript (preprint) (Other academic)
Keywords
randomised controlled trial, odontoid fractures, spinal fracture, elderly, surgery, treatment
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-333898 (URN)
Available from: 2017-11-18 Created: 2017-11-18 Last updated: 2018-01-13

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