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Objectives and questions: Odontoid fractures are a common injury in geriatric patients. However, the management of Anderson-D’Alonzo Type 2 fractures remains controversial. While some authors advocate for conservative management of such fractures, prompt surgical treatment may reduce long-term morbidity and mortality and improve functional outcomes in elederly patients. Surgical stabilization can generally be achieved through either anterior screw osteosynthesis or posterior instrumentation.This study aimed to analyze the self-reported clinical and functional outcomes of patients with odontoid fractures treated with anterior screw osteosynthes.

Material and methods: This was a retrospective case series of patients who underwent anterior screw osteosynthesis for Anderson-D’Alonzo Type 2 odontoid fractures between 2012 and 2019 at a level 1 trauma center. We analyzed demographic, clinical, radiographic and patient-reported functional and quality-of-life outcomes in this cohort. The following questionnaires were used: SF-36, Neck Disability Index (NDI), EQ-5D-5L.

Results: A total of 82 patients were analyzed (40 men and 42 women). The mean age was 76 +/- 16.4 years and the mean BMI was 24.3 +/- 3.8. 65% of patients were classified ASA 1–3. Of the 82 patients, 26 were available to answer self-reported outcome questionnaires.Intraoperative complications occured in 4 patients (5%), including 1 vascular injury and 1 esophageal injury. Reoperation was performed in 6 patients (7%). The rate of nonunion was 44% (n = 36).The average SF-36 physical composite score was 42 +/- 12, while the mental composite score was 50 +/- 9. The average NDI score was 7 +/- 8. The average EQ-5D-5L Index score was 0.79 +/- 0.36.We did not identify a difference in any of the PROMs according to whether the fracture healing resulted in a nonunion or not (p < 0.05).

Discussion and conclusions: Anterior screw osteosynthesis results in good clinical and functional outcomes for the treatment of odontoid fractures Anderson-D’Alonzo Type 2 in elderly patients, with a low complication rate. The high rate of nonunion did not seem to affect the functional and quality-of-life outcomes.