NONOPERATIVE MANAGEMENT OF ODONTOID FRACTURES USING A HALOTHORACIC VEST

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 522-530 ◽  
Author(s):  
Patrick Platzer ◽  
Gerhild Thalhammer ◽  
Kambiz Sarahrudi ◽  
Florian Kovar ◽  
Gyoergy Vekszler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Fracture Healing ◽  
Nonoperative Management ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Long Term Results ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Appropriate Treatment

Abstract OBJECTIVE Despite various reports in the literature, the appropriate treatment of Type II odontoid fractures remains controversial. Although there is an increasing tendency toward surgical treatment of these fractures in recent years, nonoperative treatment strategies are still regarded as a practicable method, particularly in elderly patients with significant comorbidities. One purpose of this study was to determine the functional and radiographic long-term results after rigid immobilization of Type II odontoid fractures using a halothoracic vest. The second aim was to present a case-control series of patients with nonunion of Type II odontoid fractures compared with patients with successful fracture healing to determine specific risk factors for failure of halo immobilization. METHODS We reviewed the clinical and radiographic records of 90 patients with an average age of 69 years at the time of injury who had undergone nonoperative treatment of odontoid fractures using a halothoracic vest between 1988 and 2004. To identify potential risk factors for failure of halo fixation, patients were divided into “cases” and “controls.” Cases were defined as patients with nonfusion after halo immobilization, and controls were patients with successful fracture healing attained with this treatment option. RESULTS Seventy-five patients returned to their preinjury activity level and were satisfied with their treatment. The Smiley-Webster scale showed an overall functional outcome score of 1.64. Successful fracture healing was achieved in 76 patients (84%). In 14 patients, nonunion was diagnosed by standard x-rays and additional computed tomographic scans within 6 to 12 months after trauma. Referring to possible risk factors for failure of halo fixation, nonunion was found significantly more often in older patients and in those with displaced fractures of the odontoid. Secondary loss of reduction and delay of treatment were identified as further risk factors for nonfusion. CONCLUSION With regard to successful fracture healing and functional results of the patients, we had a satisfactory outcome after halo fixation of Type II odontoid fractures. Although a fusion rate of 84% should not be deemed as optimal, nonoperative management of these fractures using a halothoracic vest seems to be an appropriate treatment strategy in patients who are not suitable for surgical treatment.

Surgical Treatment of Unstable Type II Odontoid Fractures in Skeletally Mature Individuals

Spine ◽  
2010 ◽  
Vol 35 (Supplement) ◽  
pp. S209-S218 ◽  
Author(s):  
Alpesh A. Patel ◽  
Ron Lindsey ◽  
Jason T. Bessey ◽  
Jens Chapman ◽  
Raja Rampersaud
Keyword(s):  
Surgical Treatment ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Unstable Type

Risk Factors for Failed Nonoperative Treatment and Rerupture in Acute Achilles Tendon Rupture

2018 ◽  
Vol 39 (6) ◽  
pp. 694-703 ◽  
Author(s):  
Aleksi Reito ◽  
Hanna-Liina Logren ◽  
Katri Ahonen ◽  
Heikki Nurmi ◽  
Juha Paloneva
Keyword(s):  
Risk Factors ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Factors Associated ◽  
Increased Risk ◽  
Male Patients

Background: Nonoperative treatment is feasible in most patients with acute Achilles tendon rupture. Risk factors associated with failed nonoperative treatment are poorly understood. We investigated risk factors associated with rerupture after nonoperative treatment and otherwise failed nonoperative treatment of Achilles tendon rupture. Methods: All patients diagnosed with acute Achilles tendon rupture between January 2009 and June 2016 and who underwent 8 weeks of nonoperative treatment with functional rehabilitation were included in the study. Patients with rerupture or otherwise failed nonoperative treatment were identified retrospectively. Time to rerupture and association of age, sex, time from injury, diabetes, and visits to the physiotherapist for cases of reruptures and otherwise failed nonoperative treatment were investigated. A total of 210 patients were included in the study. Results: Fifteen patients sustained a rerupture. Rerupture incidence was 7.1%. Incidence of late reruptures, those occurring after return to daily activities at 12 weeks, was 1.9%. Six patients had otherwise failed nonoperative treatment. Median time to rerupture was 23 days (6 to 61) after the end of the treatment. The incidence of all-cause failure was 10.0%. Male gender was associated with reruptures ( P = .013) and failed nonoperative treatment for any reason ( P = .029). Conclusion: It is important to highlight the increased risk of rerupture in male patients during the first month after the end of the nonoperative treatment. Age alone, even in male patients, was a poor indication for operative treatment since it did not predict early failure. Further studies will hopefully clarify the influence of activity level on the risk of rerupture. Level of Evidence: Level IV, retrospective case series.

scholarly journals Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Technique and Technical Report

2020 ◽  
Author(s):  
Vit Kotheeranurak ◽  
Khanathip Jitpakdee ◽  
Phattareeya Pholprajug ◽  
Pritsanai Pruttikul ◽  
Weerasak Singhatanadgige ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Screw Fixation ◽  
Invasive Technique ◽  
Type Ii ◽  
Level Of Evidence ◽  
Odontoid Fractures ◽  
Technical Report ◽  
Effective Option ◽  
Cervical Motion ◽  
Cervical Spine Fractures

Abstract Background: Odontoid fractures are common among cervical spine fractures and are categorized into three types. Unstable type II fractures are among the most challenging to treat, and the best treatment approach has been debated. Anterior odontoid screw fixation, a surgical treatment option, yields a high union rate and helps preserve cervical motion; however, there are risks for approach-related complications. Here, we report a novel minimally invasive technique of full-endoscopic anterior odontoid fixation (FEAOF).Methods: The authors introduce the technique and describe in detail the technical approach of FEAOF for the surgical treatment of type II odontoid fractures.Conclusions: FEAOF is a feasible and effective option for treating type II odontoid fractures. The procedure is less invasive than other techniques and provides clear direct visualization of the involved structures.Level of Evidence: Not applicable

Surgical Treatment of Acute Type II and Rostral Type III Odontoid Fractures Managed by Anterior Screw Fixation

2005 ◽  
Vol 98 (9) ◽  
pp. 895-900 ◽  
Author(s):  
Kostas N. Fountas ◽  
Theofilos G. Machinis ◽  
Eftychia Z. Kapsalaki ◽  
Vassilios G. Dimopoulos ◽  
Carlos H. Feltes ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Screw Fixation ◽  
Acute Type ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Type Iii ◽  
Anterior Screw Fixation

Anterior Cruciate Ligament Reconstruction versus Nonoperative Treatment: Better Function and Less Secondary Meniscectomies But No Difference in Knee Osteoarthritis—A Meta-Analysis

Cartilage ◽  
2021 ◽  
Vol 13 (1_suppl) ◽  
pp. 1658S-1670S
Author(s):  
Marco Cuzzolin ◽  
Davide Previtali ◽  
Stefano Zaffagnini ◽  
Luca Deabate ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Level Of Evidence ◽  
Knee Oa ◽  
Anterior Cruciate ◽  
The Impact

Objectives The impact of anterior cruciate ligament (ACL) reconstruction on knee osteoarthritis (OA) is still unclear. The aim of the current meta-analysis was to compare surgical treatment versus nonoperative management of ACL tears to assess the impact of these approaches on knee OA development at a 5 and 10 years of follow-up. Design A meta-analysis was performed after a systematic literature search (May 2021) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Both randomized and nonrandomized comparative studies with more than 5 years of follow-up were selected. Influence of the treatment was assessed in terms of knee OA development, subjective and objective clinical results, activity level, and risk of further surgeries. Risk of bias and quality of evidence were assessed following the Cochrane guidelines. Results Twelve studies matched the inclusion criteria, for a total of 1,004 patients. Level of evidence was rated low to very low. No difference was documented in terms of knee OA development, Tegner score, subjective International Knee Documentation Committee (IKDC), and Lysholm scores. A significant difference favoring the surgical treatment in comparison with a nonsurgical approach was observed in terms of objective IKDC score ( P = 0.03) and risk of secondary meniscectomy ( P < 0.0001). The level of evidence was considered very low for subjective IKDC, low for knee OA development, objective IKDC, number of secondary meniscectomies, and Lysholm score, and moderate for post-op Tegner score. Conclusions The meta-analysis did not support an advantage of ACL reconstruction in terms of OA prevention in comparison with a nonoperative treatment. Moreover, no differences were reported for subjective results and activity level at 5 and 10 years of follow-up. On the contrary, patients who underwent surgical treatment of their ACL tear presented important clinical findings in terms of better objective knee function and a lower rate of secondary meniscectomies when compared with conservatively managed patents. Protocol Registration: CRD420191156483 (PROSPERO)

PLATE FIXATION OF ODONTOID FRACTURES WITHOUT C1–C2 ARTHRODESIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 726-733 ◽  
Author(s):  
Patrick Platzer ◽  
Gerhild Thalhammer ◽  
Anna Krumboeck ◽  
Rupert Schuster ◽  
Florian Kutscha-Lissberg ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Plate Fixation ◽  
Activity Level ◽  
Rigid Fixation ◽  
Atlantoaxial Joint ◽  
Anterior Plate ◽  
Odontoid Fractures ◽  
Patient Reported ◽  
Pain Symptoms ◽  
Fracture Compression

Abstract OBJECTIVE Surgical treatment of odontoid fractures that do not allow interfragmentary fracture compression involves either posterior atlantoaxial arthrodesis or additional anterior stabilization using a plate construct. The purpose of this study was to determine the clinical and radiographic outcome after anterior plate fixation of odontoid fractures that were not suitable for anterior screw fixation. METHODS We reviewed the clinical and radiographic records of 9 patients with an average age of 54 years at the time of surgery who had undergone anterior plate fixation of an odontoid fracture. Indications for using a plate construct were odontoid fractures with anterior oblique fracture lines, fractures with comminution or major displacement, and pathological fractures. RESULTS Eight patients returned to their preinjury activity level and were satisfied with their treatment. One patient reported chronic pain symptoms and a notable decrease in cervical spine motion. Using the Smiley-Webster Scale to quantify their clinical outcome, we achieved an overall outcome score of 1.6. Bony fusion was achieved in all patients. Reduction or fixation failed in 2 patients. Reoperation for technical failures was not necessary in any of the patients. CONCLUSION We had promising results using anterior plate fixation for surgical treatment of odontoid fractures that did not allow interfragmentary fracture compression. Because this method avoids the rigid fixation of the atlantoaxial joint in contrast to techniques of posterior cervical arthrodesis, it seems to be a practical option for the management of fracture types that require additional stabilization of the odontoid.

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
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