scholarly journals Management of Odontoid Fractures in the Elderly: A Review of the Literature and an Evidence-Based Treatment Algorithm

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 419-430 ◽  
Author(s):  
Sravisht Iyer ◽  
R John Hurlbert ◽  
Todd J Albert
Keyword(s):  
Bone Health ◽  
Nonoperative Management ◽  
Management Strategies ◽  
Treatment Algorithm ◽  
The Elderly ◽  
Operative Management ◽  
Cervical Spine Fracture ◽  
Type I ◽  
Related Factors ◽  
Odontoid Fractures

Abstract Odontoid fractures are the most common fracture of the axis and the most common cervical spine fracture in patients over 65. Despite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. Poor bone health and medical comorbidities contribute to increased surgical risk in this population; however, nonoperative management is associated with a risk of nonunion or fibrous union. We provide a review of the existing literature and discuss the classification and evaluation of odontoid fractures. The merits of operative vs nonoperative management, fibrous union, and the choice of operative approach in elderly patients are discussed. A treatment algorithm is presented based on the available literature. We believe that type I and type III odontoid fractures can be managed in a collar in most cases. Type II fractures with any additonal risk factors for nonunion (displacement, comminution, etc) should be considered for surgical management. However, the risks of surgery in an elderly population must be carefully considered on a case-by-case basis. In a frail elderly patient, a fibrous nonunion with close follow-up is an acceptable outcome. If operative management is chosen, a posterior approach is should be chosen when fracture- or patient-related factors make an anterior approach challenging. The high levels of morbidity and mortality associated with odontoid fractures should encourage all providers to pursue medical co-management and optimization of bone health following diagnosis.

scholarly journals Therapeutic management in an elderly patient with odontoid fracture

2016 ◽  
Vol 16 (4) ◽  
pp. 201-207
Author(s):  
Wojciech Ilków ◽  
◽  
Tomasz Krzeszowiec ◽  
Dariusz Łątka ◽  
◽  
...  
Keyword(s):  
Cervical Spine ◽  
Odontoid Process ◽  
The Elderly ◽  
Common Type ◽  
Odontoid Fracture ◽  
Therapeutic Management ◽  
Cervical Spine Fracture ◽  
Odontoid Fractures ◽  
Regional Medical ◽  
Comprehensive Discussion

Fracture of the odontoid process is the most common type of cervical spine fracture in elderly patients (i.e. population over the age of 70 years), which can lead to disability or death. The therapeutic management depends on imaging findings and patient’s general condition. The authors present a case of a 71-year-old patient diagnosed with odontoid fracture based on cervical spine computed tomography, who received surgical treatment in the Department of Neurosurgery of the Regional Medical Centre in Opole. The problem of odontoid fractures in the elderly has been a subject of a comprehensive discussion.

Current controversies in nonoperative management of Type II odontoid fractures in the elderly

2014 ◽  
Vol 26 (3) ◽  
pp. 187-191
Author(s):  
Megan Carroll Paulus ◽  
Samuel Klatman ◽  
S. Babak Kalantar
Keyword(s):  
Nonoperative Management ◽  
The Elderly ◽  
Type Ii ◽  
Odontoid Fractures

Nonoperative Management of Type II Odontoid Fractures in the Elderly

Spine ◽  
2008 ◽  
Vol 33 (26) ◽  
pp. 2881-2886 ◽  
Author(s):  
Florentius Koech ◽  
Helen M. Ackland ◽  
Dinesh K. Varma ◽  
Owen D. Williamson ◽  
Gregory M. Malham
Keyword(s):  
Nonoperative Management ◽  
The Elderly ◽  
Type Ii ◽  
Odontoid Fractures

Operative versus nonoperative management of acute odontoid Type II fractures: a meta-analysis

2009 ◽  
Vol 11 (6) ◽  
pp. 651-658 ◽  
Author(s):  
Ali Nourbakhsh ◽  
Runhua Shi ◽  
Prasad Vannemreddy ◽  
Anil Nanda
Keyword(s):  
Nonoperative Management ◽  
Screw Fixation ◽  
Meta Analysis ◽  
Operative Management ◽  
Fusion Rate ◽  
Acute Type ◽  
Type Ii ◽  
Halo Vest ◽  
Odontoid Fractures ◽  
Fracture Displacement

Object The purpose of this study was to evaluate the feasibility of the criteria described in the literature as the indications for surgery for acute Type II odontoid fractures. Methods The authors searched the PubMed database for studies in which the fusion rate of acute Type II odontoid fractures following external immobilization (halo vest or collar) or surgery (posterior C1–2 fusion or anterior screw fixation) was reported. The only studies included reported the fusion rate for either 1) groups of patients whose age was either more or less than a certain age range (45–55 years); or 2) groups of patients with a fracture displacement of either more or less than a certain odontoid fracture displacement (4–6 mm) or the direction of displacement (see Methods section of text for more details). A meta-analysis in which the random effect model was used was conducted to analyze the data. Results There was a statistically significantly higher fusion rate for operative management compared with external immobilization (85 vs 60%, p = 0.01) for the patients > 45–55 years. However, the overall fusion rate was > 80% for the patients whose age was < 45–55 years, regardless of treatment modality, and no significant differences were observed between surgically and nonsurgically treated patients (89 and 81%, respectively; p = 0.29). The result of operation (overall fusion rate 89%) was superior to external immobilization (44%) when the fracture was posteriorly displaced (p < 0.001), but for anteriorly displaced fractures, the results of operative and nonoperative management were identical (p = 0.15). The overall fusion rate of operative management of both anteriorly and posteriorly displaced fractures proved to be > 85%, and no statistically significant difference was observed (p = 0.50). For all degrees of displacement (either > or < 4–6 mm) the operation proved to provide significantly better results than conservative treatment. The fusion rate of conservatively treated fractures with < 4–6 mm displacement was significantly better than in fractures with > 4–6 mm displacement (76 vs 41%, p = 0.002). Conclusions Operative treatment (posterior C1–2 fixation or anterior screw fixation) provides a better fusion rate than external immobilization for acute odontoid Type II fractures, although in certain situations, such as anterior displacement of the fracture and for younger (< 45–55 years of age) patients, conservative management (halo vest or collar immobilization) can be as effective as surgery. Operative management is recommended in older patients, in cases of posterior displacement of the fracture, and when there is displacement of > 4–6 mm.

scholarly journals Management of a spontaneous supra-aortic arterial dissection: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Omar M. Sharaf ◽  
Tomas D. Martin ◽  
Eric I. Jeng
Keyword(s):  
Innominate Artery ◽  
Operative Management ◽  
Computed Tomographic Angiography ◽  
Artery Dissection ◽  
Term Therapy ◽  
Type I ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Aortic Dissections ◽  
Isolated Innominate Artery

Abstract Background Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae. Case presentation A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management—anti-impulse regimen, antiplatelet therapy, and close follow-up. Conclusions Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary.

scholarly journals Supply and Demand-Related Decisive Factors in the Utilization of Non-Medical Community Healthcare Services among Elderly Chinese

2020 ◽  
Vol 18 (1) ◽  
pp. 228
Author(s):  
Zhao Yu ◽  
Lijian Wang ◽  
Tolulope Ariyo
Keyword(s):  
Supply And Demand ◽  
The Elderly ◽  
Healthcare Services ◽  
Medical Community ◽  
Quality Service ◽  
Related Factors ◽  
Community Healthcare ◽  
Elderly Chinese ◽  
Service Need ◽  
Community Healthcare Services

There is little research on the utilization of non-medical community healthcare services among the elderly, compared with that of medical community healthcare services. From the perspective of both supply and demand, based on the survey data from Shaanxi province, this study examined supply-related factors (including service supply, service quality, service charge and service accessibility) and demand-related factors (including service need, individual financial status, family care support and knowledge of service) affecting the utilization of non-medical community healthcare services among the elderly in China by using Poisson regression. The findings show that service supply, service quality, service need and knowledge of service are positively associated with the utilization of non-medical community healthcare services among elderly Chinese, but the other factors identified in previous studies are not significant predictors for the utilization of the services among the elderly in the context of China. To our knowledge, this is the first study to examine both supply-related factors and demand-related factors affecting the utilization of non-medical community healthcare services among elderly Chinese.

scholarly journals Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

2021 ◽  
Vol 38 (01) ◽  
pp. 105-112
Author(s):  
Majd Habash ◽  
Darrel Ceballos ◽  
Andrew J. Gunn
Keyword(s):  
Clinical Outcomes ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Artery Embolization ◽  
Splenic Artery Embolization

AbstractThe spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.

Odontoid Fractures, with Special Reference to the Elderly Patient

1985 ◽  
Vol &NA; (193) ◽  
pp. 178???183 ◽  
Author(s):  
J. W. PEPIN ◽  
R. B. BOURNE ◽  
R. J. HAWKINS
Keyword(s):  
Elderly Patient ◽  
Special Reference ◽  
The Elderly ◽  
Odontoid Fractures

Operative Versus Nonoperative Management of Odontoid Fracture in the Elderly: Stochastic Simulation of Morbidity and Mortality

2011 ◽  
Vol 11 (10) ◽  
pp. S107
Author(s):  
Suneel Bhat ◽  
Christopher Kepler ◽  
Kris Radcliff ◽  
Jeffrey Rihn ◽  
Todd Albert ◽  
...  
Keyword(s):  
Stochastic Simulation ◽  
Nonoperative Management ◽  
The Elderly ◽  
Odontoid Fracture ◽  
Morbidity And Mortality

216 Fix or Replace: Is Internal Fixation Still A Viable Option in The Elderly with Un-Displaced Intracapsular Femoral Neck Fractures?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Morris ◽  
A Krishna ◽  
H Hamid ◽  
M Chawda ◽  
H Mumtaz
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Revision Surgery ◽  
Retrospective Review ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Cannulated Screws ◽  
Viable Option ◽  
Displaced Femoral Neck Fractures

Abstract Aim The treatment of impacted or un-displaced femoral neck fractures in the elderly osteoporotic patient is still largely debated, with arthroplasty versus internal fixation two surgical options1. Our aim was to retrospectively review patients over the age of 80 with un-displaced intracapsular hip fractures who had undergone internal fixation and assess their rate of mortality and revision surgery. Method We conducted a retrospective review of all patients with femoral neck fractures over a 4-year period between January 2015 to December 2018. We refined this to only patients over the age of 80 with un-displaced intracapsular femoral neck fractures fixed with cannulated screws. We noted their mental and mobility status, their follow-up attendance over 3 years, their mortality and rate of revision surgery. Results There were a total of 1232 femoral neck fractures in a 4-year period. Of these, 37 were &gt;80 with un-displaced intracapsular femoral neck fractures, with 23 fixed with cannulated screws and 14 with a Dynamic Hip Screw. Mean age – 85, M:F (1:4.75). All patients were either Garden Classification Type I or II. 4% had cognitive impairment. All patients were independently mobile. 83% were followed up for 3 years, with 1 patient (4%) undergoing revision surgery 3 years following cannulated screw fixation. The 30-day mortality rate was 5%. Conclusions The treatment choice for un-displaced intracapsular femoral neck fractures in the elderly remains debateable. Our retrospective review shows that the rate of re-operation is low in patients who have undergone fixation with cannulated screws and so this remains a viable option.

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