gms | German Medical Science

Objectives: The appropriate treatment of dens fractures in the elderly still remains controversial. Based on the literature and on our own experience we established a treatment protocol for geriatric patients.

Methods: We included retrospectively 152 patients, 95 patients greater than 75 yrs, from May 2003 until March 2017. We categorized each patient with radiographs and CT-scans to evaluate the type of fracture, fracture gap (mm), fracture angulation (°), fracture displacement (mm) and direction (anterior, posterior). The fractures were stratified as stable (displacement <4.5mm, angulation <15°) or unstable. Stable fractures were treated with a non-rigid immobilization, unstable fractures surgically.

Result: We encountered 65 stable and 30 unstable fractures. For stable fractures the average dens angulation was 13° and 1.8mm displaced. The observed non-union rate was 25% of which 2 patients underwent a secondary posterior transarticular fixation. The other 14 patients had either stable nonunions or could not undergo a surgery. Surgical intervention was performed in 30 patients with an average dens angulation of 21° and 5.2mm displacement. A posterior C1-C2 fusion was carried out in 24 patients (80%), a C0 onto C4 stabilization in 3 (10%) and an anterior odontoid screw fixation in 3 patients (10%). For direct anterior screw fixation there was 1 non-union, which was revised, for posterior C1/2 fixation the union rate was 100%.

Conclusion: The need for surgical intervention in patients greater than 75 years is a fracture dislocation >4.5mm and angulation of >15°, posterior C1/2 fixation is highly successful and safe. Stable fractures can be successfully treated with non-rigid immobilization.