Functional Outcome After Odontoid Fractures in the Elderly

Self-reported complaints are common after mild traumatic brain injury (mTBI). Particularly in the elderly with mTBI, the pre-injury status might play a relevant role in the recovery process. In most mTBI studies, however, pre-injury complaints are neither analyzed nor are the elderly included. Here, we aimed to identify which individual pre- and post-injury complaints are potential prognostic markers for incomplete recovery (IR) in elderly patients who sustained an mTBI. Since patients report many complaints across several domains that are strongly related, we used an interpretable machine learning (ML) approach to robustly deal with correlated predictors and boost classification performance. Pre- and post-injury levels of 20 individual complaints, as self-reported in the acute phase, were analyzed. We used data from two independent studies separately: UPFRONT study was used for training and validation and ReCONNECT study for independent testing. Functional outcome was assessed with the Glasgow Outcome Scale Extended (GOSE). We dichotomized functional outcome into complete recovery (CR; GOSE = 8) and IR (GOSE ≤ 7). In total 148 elderly with mTBI (median age: 67 years, interquartile range [IQR]: 9 years; UPFRONT: N = 115; ReCONNECT: N = 33) were included in this study. IR was observed in 74 (50%) patients. The classification model (IR vs. CR) achieved a good performance (the area under the receiver operating characteristic curve [ROC-AUC] = 0.80; 95% CI: 0.74–0.86) based on a subset of only 8 out of 40 pre- and post-injury complaints. We identified increased neck pain (p = 0.001) from pre- to post-injury as the strongest predictor of IR, followed by increased irritability (p = 0.011) and increased forgetfulness (p = 0.035) from pre- to post-injury. Our findings indicate that a subset of pre- and post-injury physical, emotional, and cognitive complaints has predictive value for determining long-term functional outcomes in elderly patients with mTBI. Particularly, post-injury neck pain, irritability, and forgetfulness scores were associated with IR and should be assessed early. The application of an ML approach holds promise for application in self-reported questionnaires to predict outcomes after mTBI.

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Surgical versus nonsurgical management for type II odontoid fractures in the elderly population: a systematic review

The Spine Journal ◽

10.1016/j.spinee.2018.05.017 ◽

2018 ◽

Vol 18 (10) ◽

pp. 1921-1933 ◽

Cited By ~ 9

Author(s):

Deep P. Sarode ◽

Andreas K. Demetriades

Keyword(s):

Systematic Review ◽

Elderly Population ◽

The Elderly ◽

Type Ii ◽

Odontoid Fractures ◽

Nonsurgical Management

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Comparative study of cast immobilization of wrist in functional position versus conventional palmar flexion in Colles’ fracture

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i3.32040 ◽

2020 ◽

Vol 10 (3) ◽

pp. 47-52

Author(s):

Shriraj Shrestha ◽

Parash Bhandari ◽

Saurav Dahal ◽

Basanta Maharjan ◽

Suraj Bajracharya

Keyword(s):

Functional Outcome ◽

Scoring System ◽

College Teaching ◽

The Elderly ◽

Fracture Site ◽

Cast Immobilization ◽

Medical College ◽

Colles Fracture ◽

Grip Power ◽

Palmar Flexion

Background: Colles’ fracture is a common injury in the elderly population. Although it can be easily reduced, it is difficult to maintain the reduction in the conventional position of the wrist in palmar flexion with a poor functional outcome. Thus our study aimed to compare the radiological and functional outcome of such fractures with the wrist in two different positions of dorsiflexion and palmar flexion. Methods: A prospective, observational study was conducted from April 2019 to March 2020 in the Orthopedics and Emergency department of KIST Medical College Teaching Hospital, Lalitpur, Nepal. Sixty-two patients, 31 in each group, all above 45 years with Colles’ fracture underwent close reduction and below elbow cast immobilization under hematoma block. Maintaining palmar flexion and ulnar deviation at the fracture site, the wrist was immobilized in dorsiflexion and palmar flexion attitude alternatively. During the respective follow-ups, the Demerit Scoring System of Saito was evaluated. Data collection and entry was done using the statistical package for social science version 16 and analyzed by using descriptive and inferential statistics. Results: All fractures were united. At the end of twelve weeks, Saito Scoring System of good to excellent was markedly better in dorsiflexed group 29(93.5%) patients as compared to palmar flexed group 22(71.0%) patients, similarly grip power was also superior in dorsiflexed group 19(61.3%) patients than in palmar flexed group 11(35.5%) patients. Conclusions: Cast immobilization of Colles’ fracture with the wrist in dorsiflexion prevents re-displacement of the fragments resulting in significantly better radiological and functional outcomes.

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Prestroke Physical Activity and Poststroke Cognitive Performance

Cerebrovascular Diseases ◽

10.1159/000511490 ◽

2020 ◽

Vol 49 (6) ◽

pp. 632-638

Author(s):

Andreas Gammelgaard Damsbo ◽

Janne Kaergaard Mortensen ◽

Kristian Lundsgaard Kraglund ◽

Søren Paaske Johnsen ◽

Grethe Andersen ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Impairment ◽

Functional Outcome ◽

Cognitive Performance ◽

Mini Mental State Examination ◽

The Elderly ◽

Protective Measure ◽

Multivariable Analyses ◽

State Examination ◽

Physical Activity Scale

Introduction: Physical activity (PA) is associated with a lower risk of stroke and stroke mortality as well as a favorable stroke outcome. PA may also prevent general cognitive decline. Poststroke cognitive impairment is both common and disabling, and focusing on all possible preventive measures is important. Studies on the effect of PA on poststroke cognitive performance are sparse, however. We therefore aimed to examine the association between prestroke PA and poststroke cognitive performance. Methods: We studied the correlation between prestroke PA and poststroke cognitive performance in a prespecified analysis in The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS) trial. We used the Physical Activity Scale for the Elderly (PASE) to collect information on PA during the 7-day period before stroke. PA was quantified, and patients were stratified into quartiles based on their PASE score. Cognitive performance was measured using the Symbol Digit Modalities Test (SDMT) at 1 and 6 months and the Mini-Mental State Examination (MMSE) at 6 months. The functional outcome was assessed using the modified Rankin Scale (mRS). Results: In total, 625 of 642 patients (97%) completed the PASE questionnaire. The median age was 69 (interquartile range [IQR]: 60–77), and the median PASE score was 137 (82–205). Higher prestroke PASE quartiles (2nd, 3rd, and 4th, each compared to the 1st) were independently associated with a higher SDMT score at 1 month in the both the univariable and multivariable analyses (2nd: 3.99 points, 95% confidence interval [CI]: 1.01–6.97; 3rd: 3.6, CI: 0.6–6.61; 4th: 4.1, CI: 0.95–7.24). This association remained at 6 months. PA was not statistically associated with the MMSE score or mRS. Conclusion: Higher prestroke PA was associated with a better cognitive performance as measured by the SDMT at 1 and 6 months poststroke. We found no significant association between prestroke PA and functional outcome. Our results are encouraging and support further investigations of PA as a protective measure against poststroke cognitive impairment.

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Rationale and design of the INNOVATE Trial: an international cooperative study on surgical versus conservative treatment for odontoid fractures in the elderly

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-15-7 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 9

Author(s):

Jeroen GJ Huybregts ◽

Wilco CH Jacobs ◽

Wilco C Peul ◽

Carmen LA Vleggeert-Lankamp

Keyword(s):

Conservative Treatment ◽

The Elderly ◽

Cooperative Study ◽

Odontoid Fractures

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Treatment of type II odontoid fracture in the elderly

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa235 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Preci Hamilton ◽

Peyton Lawrence ◽

Christian Valentin Eisenring

Keyword(s):

Screw Fixation ◽

Holistic Approach ◽

The Elderly ◽

Spinal Fracture ◽

Cannulated Screw ◽

Odontoid Fracture ◽

Zenker’S Diverticulum ◽

Type Ii ◽

Odontoid Fractures ◽

Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

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