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

Department of Radiology

P. Myllynen, MD, PhD, Consultant Orthopaedic Surgeon; and S. Santavirta, MD, PhD, Professor of Orthopaedic Surgery

Department of Orthopaedics and Traumatology Helsinki University Central Hospital, Topeliuksenkatu 5, PO Box 266, FIN-00029 HUS, Finland.

L. Kivisaari, MD, PhD, Professor of Radiology

Department of Radiology, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 340, FIN-00029 HUS, Finland.

Correspondence should be sent to Dr M. P. Koivikko.

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 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.

This article has been cited by other articles:

				D. S. KORRES, G. D. CHLORES, and G. S. THEMISTOCLEOUS Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process J Bone Joint Surg Br, January 1, 2006; 88-B(1): 137 - 137. [Full Text] [PDF]

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