Citation

Alas H, Segreto FA, Chan HY, Brown AE, Pierce KE, Bortz CA, Horn SR, Varlotta CG, Baker JF, Passias PG. J. Orthop. Trauma 2019; ePub(ePub): ePub.

Affiliation

Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000001597

PMID

31365449

Abstract

OBJECTIVES: Determine significant associations between patient frailty status and odontoid fractures across common traumatic mechanisms of injuries (MOI) in the elderly.

DESIGN: Retrospective review. SETTING: Single, academic-affiliated hospital with full surgical servicesPatients/Participants: Patients >65 years old with traumatic odontoid fracture were included. INTERVENTION: Non-operative management (soft/hard collar, halo, traction tongs, minerva) and/or operative fixation. MAIN OUTCOME MEASUREMENTS: mFI, MOI, concurrent injuries, inpatient LOS, reoperation and mortality rates.

RESULTS: 70 patients were included (80.6±8.5yrs, 60%F, 88% European, 10% Maori/Pacific, 1.4% Asian, CCI 5.3± 2.2, mFI 0.21±0.15). The most common MOIs were Falls (74.3%), high speed MVAs (17.1%), low speed MVAs (5.7%), and pedestrian vs car (2.9%). Patients with traumatic falls exhibited significantly higher mFI scores (0.25) compared to low speed MVAs (0.16), high speed MVAs (0.08), and pedestrian vs car (0.01) (p=0.003). Twenty-seven patients with odontoid fractures were Frail, 33 were Pre-frail, and 10 were Robust. 92% of Frail patients had traumatic fall as their MOI, as opposed to 73% of Pre-frail and 30% of Robust patients (p<0.001). Pre-frail and Frail patients were 4.3 times more likely than Robust patients to present with odontoid fractures via traumatic fall (OR: 4.33 [1.47-12.75], p=0.008), and frailty increased likelihood of reoperation (OR: 4.2 [1.2-14.75], p=0.025) and extended LOS (OR: 5.71 [1.05-10.37], p=0.017). Frail patients had the highest 30-day (p=0.017) and 1-year mortality (p<0.001) compared to other groups.

CONCLUSION: Patients with traumatic odontoid fracture from falls were significantly more frail in comparison to any other MOI, with worse short and long-term outcomes. LEVEL OF EVIDENCE: Level III Retrospective Cohort Study.

Language: en