Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly

This study is a retrospective analysis of patients older than 65 years with odontoid fractures. The series consisted of 29 consecutive patients with o dontoid fractures (18 women, mean age 78, range 66-99 years). Twenty-six pa tients were neurologically intact, Frankel E, whereas three had neurologica l symptoms: two Frankel D and one Frankel C. Eleven patients were treated w ith anterior screw Fixation according to Bohler, seven with a posterior C1- C2 fusion. Ten patients with either minimally displaced fractures or with c omplicating medical conditions were treated conservatively. At follow-up, 7 /7 patients with posterior fusion had healed without any problems, whereas 8/11 patients treated with anterior screw fixation, and 7/10 conservatively treated patients were either Failures or had healed, but after a complicat ed course of events. We conclude that anterior screw fixation according to Bohler is associated with an unacceptably high rate of problems in the elde rly. Probable causes may be osteoporosis with comminution at the fracture s ite, or stiffness of the cervical spine preventing ideal positioning of the screws. As non-operative treatment also often fails, the method of choice seems to be posterior C1-C2 fusion.