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    2. Deutscher Kongress für Orthopädie und Unfallchirurgie 2025 (DKOU 2025)
    3. Mortality of non-operatively treated Type II odontoid fractures in the elderly: Does modality matter?
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German Congress of Orthopaedics and Traumatology (DKOU 2025)

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berufsverband für Orthopädie und Unfallchirurgie (BVOU)
28.-31.10.2025
Berlin


Meeting Abstract

Mortality of non-operatively treated Type II odontoid fractures in the elderly: Does modality matter?

Leroy Gov 1
Henrik Baecker 1
1Auckland City Hospital, Auckland, Neuseeland

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Objectives and questions: Type II odontoid fractures have been thought to be associated with increased mortality. Considering this, the current goldstandard in literature remains surgery. Until today non operative treatment still remains controversial because of a high non-union rate.

The purpose of this study was to investigate the mortality outcomes of different non-operative modalities for elderly patients with Type II odontoid fractures.

Material and methods: A retrospective study of our prospective trauma registry was performed including all consecutive adult patients with type II odontoid fractures between December 2003 and July 2023. Data on patient demographics, radiographic parameters, treatment, and mortality rate after 6-weeks, 3-months and 1-year were collected. The data was analyzed via the Pearson Correlation Coefficient using SPSS.

Results: A total of 56 patients were included who had an average age of 83.79±9.87 years at time of injury. The overall mortality rate was 69.64% with a mean maximal follow-up of 4.09±4.07 years. The average age at death was 89.45±8.73 years. The mean time from injury to death was 3.04±3.84 years. The 6-week, 3-month and 1-year mortality rates were 10.71%, 17.86% and 30.36% respectively. Management with Soft collar compared to hard collar was significantly associated with increased 3-month (r=0.304 p<0.05) and 1 year (r=0.347 p<0.05) mortality. It however was not significantly associated with increased 6-week mortality. Management of soft collar compared to hard collar was also significantly associated with increased age (r=0.394 p=0.005) and increased Charlson comorbidity index (r=0.324 p<0.05). Both these factors were significantly associated with increased 1-year mortality for the total study population.

Discussion and conclusions: Mortality in patients with odontoid fractures is high regardless of the non-operative modality utilized. Although some mortality outcomes favoured hard collar over soft collar immobilisation, there was no significant difference with regards to 6-week mortality.