Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process

M. P. Koivikko, M. J. Kiuru, S. K. Koskinen, P. Myllynen, S. Santavirta, L. Kivisaari
2004 Journal of Bone and Joint Surgery  
In type-II fractures of the odontoid process, the treatment is either conservative in a halo vest or primary surgical stabilisation. Since nonunion, requiring prolonged immobilisation or late surgery, is common in patients treated in a halo vest, the identification of those in whom this treatment is likely to fail is important. We reviewed the data of 69 patients with acute type-II fractures of the odontoid process treated in a halo vest. The mean follow-up was 12 months. Conservative treatment
more » ... servative treatment was successful, resulting in bony union in 32 (46%) patients. Anterior dislocation, gender and age were unrelated to nonunion. However, nonunion did correlate with a fracture gap (>1 mm), posterior displacement (> 5 mm), delayed start of treatment (> 4 days) and posterior redisplacement (> 2 mm). We conclude that patients presenting with these risk factors are unlikely to achieve bony union by treatment in a halo vest. They deserve careful attention during the follow-up period and should also be considered as candidates for primary surgical stabilisation.
doi:10.1302/0301-620x.86b8.14839 pmid:15568528 fatcat:na27lde6lbbkpfdrnnvi4p6zqm