Recommendations for Diagnosis and Treatment of Odontoid Fractures in Geriatric Patients

Georg Osterhoff; Klaus Schnake; Max J. Scheyerer; Bernhard W. Ullrich; Frank Hartmann; Alexander Franck; Holger Koepp; Maximilian Reinhold; Gregor Schmeiser; Kai Sprengel; Volker Zimmermann; Holger Siekmann; Andreas Badke; Harry Gebhard; Kai C. Täubel; Sebastian Grüninger; Akhil P. Verheyden; Philipp Schleicher; Ulrich J. A. Spiegl; AG „Obere Halswirbelsäule“ und AG „Osteoporotische Frakturen“ der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie

doi:10.1055/a-0989-2791

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2020; 158(06): 647-656
DOI: 10.1055/a-0989-2791

Review/Übersicht

Recommendations for Diagnosis and Treatment of Odontoid Fractures in Geriatric Patients

Article in several languages: English | deutsch

Georg Osterhoff

¹Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig

,

Klaus Schnake

²Zentrum für Wirbelsäulen- und Skoliosetherapie, Schön Klinik Nürnberg/Fürth, Fürth

,

Max J. Scheyerer

³Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln

,

Bernhard W. Ullrich

⁴Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost GgmbH Halle/Saale

,

Frank Hartmann

⁵Zentrum für Unfallchirurgie und Orthopädie, Ev. Stift St. Martin, Gemeinschaftsklinikum Mittelrhein, Koblenz

,

Alexander Franck

⁶Klinik für Orthopädie und Unfallchirurgie, Regiomed Klinikum Coburg

,

Holger Koepp

⁷Wirbelsäulenzentrum, St. Josefs-Hospital, Wiesbaden

,

Maximilian Reinhold

⁸Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Südstadt Rostock

,

Gregor Schmeiser

⁹Klinik für Spinale Chirurgie, Schön Klinik Hamburg-Eilbek

,

Kai Sprengel

¹⁰Klinik für Traumatologie, UniversitätsSpital Zürich, Schweiz

,

Volker Zimmermann

¹¹Abt. Unfallchirurgie und Orthopädische Chirurgie, Klinikum Traunstein

,

Holger Siekmann

¹²Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle

,

Andreas Badke

¹³Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen

,

Harry Gebhard

¹⁴Departement Chirurgie, Kantonsspital Baden, Schweiz

,

Kai C. Täubel

¹⁵Orthopädisch–Unfallchirurgisches Zentrum, ALB FILS KLINIKEN, Standort Klinik am Eichert, Göppingen

,

Sebastian Grüninger

¹⁶Universitätsklinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg

,

Akhil P. Verheyden

¹⁷Klinik für Unfall-, Orthopädische und Wirbelsäulenchirurgie, Ortenau Klinikum Lahr-Ettenheim

,

Philipp Schleicher

¹⁸Wirbelsäulenzentrum und Neurotraumatologie, BGU Frankfurt am Main

,

Ulrich J. A. Spiegl

¹Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig

,

AG „Obere Halswirbelsäule“ und AG „Osteoporotische Frakturen“ der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie

› Author Affiliations

Abstract

Background Odontoid fractures in geriatric patients represent an entity of increasing incidence with a high rate of morbidity and mortality. The optimal diagnostic and therapeutic management is being controversially discussed in the literature.

Methods In a consensus process and based on the current literature, the members of the working groups “Osteoporotic Fractures” and “Upper Cervical Spine” of the German Society for Orthopaedics and Trauma Surgery (DGOU) defined recommendations for the diagnostics and treatment of odontoid fractures in geriatric patients.

Results For the diagnosis of odontoid fractures in symptomatic patients, computed tomography represents the gold standard, along with conventional radiographs. Magnetic resonance and dynamic imaging can be used as ancillary imaging modalities. With regard to fracture classification, the systems described by Anderson/DʼAlonzo and by Eysel/Roosen have proved to be of value. A treatment algorithm was developed based on these classifications. Anderson/DʼAlonzo type 1, type 3, and non-displaced type 2 fractures usually can be treated non-operatively. However, a close clinical and radiological follow-up is essential. In Anderson/DʼAlonzo type 2 fractures, operative treatment is associated with better fracture healing. Displaced type 2 and type 3 fractures should be stabilized operatively. Type 2 fractures with suitable fracture patterns (Eysel/Roosen 2A/B) can be stabilized anteriorly. Posterior C I/II-stabilization procedures are well established and suitable for all fracture patterns.

Key words

odontoid fracture - dens axis - osteoporosis - osteoporotic fracture - cervical spine

Full Text

References

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