Surgical Versus Non-Operative Treatment of Hadley Type IIA Odontoid Fractures

13/09/2011

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BACKGROUND: Type II odontoid fractures with additional chip fragments are rare in clinical practice, accounting for less than 10% of all odontoid fractures. Hadley et al. were the first to describe these fractures as an individual subtype (IIA).

OBJECTIVE: To analyze the outcome of patients following surgical or non-operative treatment of Hadley type-IIA odontoid fractures.

METHODS: We analyzed the records of 46 patients with an average age of 64 years at the time of injury. 25 patients underwent surgical stabilization by anterior screw fixation (ASF) and were entered into study group A; 21 patients were treated non-operatively by halo vest immobilisation (HVI) and included into study group B.

RESULTS: 37 patients (84%) returned to their pre-injury activity level and were satisfied with their treatment. Using the Cervical Spine Outcomes Questionnaire to quantify the clinical outcome, we had an overall outcome score of 21.8. Comparing between the study groups, we did not find a significant difference in the overall clinical outcome. Bony fusion was achieved in 35 patients (80%). Comparing between the two study groups, we had a non-union rate of 13% after ASF and a significantly higher rate of 30% following HVI. Failures of reduction or fixation occurred in 12 patients (27%), with a significantly higher failure rate after HVI.

CONCLUSION: Hadley type IIA odontoid fractures are inherently unstable and impede proper realignment. These fractures have a significantly increased risk for secondary loss of reduction and bony non-union, particularly following non-operative management. Early surgery should be considered to avoid further complications.

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