Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Details

• Personal Author:
  Arnold P ; Bono C ; Brodke D ; Chapman J ; Dekutoski M ; Fehlings MG ; France J ; Gokaslan Z ; Harrop J ; Kepler CK ; Kopjar B ; Sasso R ; Shaffrey C ; Vaccaro AR ; Yoon ST
• Description:
  Background: Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older. Methods: One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The subjects were followed at six and twelve months with validated outcome measures, including the Neck Disability Index (NDI) and Short Form-36v2 (SF-36v2). Treatment complications were prospectively recorded. Statistical analysis was performed to compare outcome measures before and after adjustment for confounding variables. Results: The two groups were similar with regard to baseline characteristics. The most common surgical treatment was posterior C1-C2 arthrodesis (eighty of 101, or 79%) while the most common nonsurgical treatment was immobilization with use of a hard collar (forty-seven of fifty-eight, or 81%). The overall mortality rate was 18% over the twelve-month follow-up period. At twelve months, the NDI had increased (worsened) by 14.7 points in the nonsurgical cohort (p < 0.0001) compared with a nonsignificant increase (worsening) of 5.7 points in the surgical group (p = 0.0555). The surgical group had significantly better outcomes as measured by the NDI and SF-36v2 Bodily Pain dimension compared with the nonsurgical group, and these differences persisted after adjustment. There was no difference in the overall rate of complications, but the surgical group had a significantly lower rate of nonunion (5% versus 21% in the nonsurgical group; p = 0.0033). Mortality was higher in the nonsurgical group compared with the surgical group (annual mortality rates of 26% and 14%, respectively; p = 0.059). Conclusions: We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates. [Description provided by NIOSH]
• Subjects:
  Age Factors Cohort Studies Mortality Musculoskeletal Diseases Musculoskeletal System Occupational Health Safety
• Keywords:
  Age Factors Bone Disorders Cohort Studies Medical Treatment Mortality Rates Neck Injuries Quality Of Life Surgery
• ISSN:
  0021-9355
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Indiana ; Kansas ; Maryland ; Massachusetts ; Minnesota ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 7 ; OSHA Region 8 ; Pennsylvania ; Utah ; Virginia ; Washington ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  95
• Issue:
  8
• NIOSHTIC Number:
  nn:20057200
• Citation:
  J Bone Jt Surg 2013 Apr; 95(8):729-735
• Contact Point Address:
  Alexander R. Vaccaro, MD, PhD, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
• Email:
  alexvaccaro3@aol.com
• Federal Fiscal Year:
  2013
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of Bone and Joint Surgery
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:fc27ef0fa83506997a33ff01566376a39f4021e5000f80db5ed240b8e56b19a1f725a42e10a6810f6491aa5ae5140a9f273f60fe8f04f833b323a83243399b33
• Download URL:
  https://stacks.cdc.gov/view/cdc/214629/cdc_214629_DS1.pdf
• File Type:
  [PDF - 498.27 KB ]