gms | German Medical Science

4. Alterstraumatologie Kongress 2018

22.03. - 23.03.2018, Zürich Regensdorf, Schweiz

Treatment Algorithm of Dens Fractures in the Geriatric Population

Meeting Abstract

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  • presenting/speaker Amelie Kanovsky - Klinikum Klagenfurt, Klagenfurt, Österreich
  • Ernst Müller - Klinikum Klagenfurt, Klagenfurt, Österreich

Deutsche Gesellschaft für Geriatrie e.V. (DGG). Deutsche Gesellschaft für Unfallchirurgie e.V. (DGU). 4. Alterstraumatologie Kongress 2018. Zürich Regensdorf, Schweiz, 22.-23.03.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc20

doi: 10.3205/18altra20, urn:nbn:de:0183-18altra209

Veröffentlicht: 13. März 2018

© 2018 Kanovsky et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objectives: The appropriate treatment of dens fractures in the elderly still remains controversial. Based on the literature and on our own experience we established a treatment protocol for geriatric patients.

Methods: We included retrospectively 152 patients, 95 patients greater than 75 yrs, from May 2003 until March 2017. We categorized each patient with radiographs and CT-scans to evaluate the type of fracture, fracture gap (mm), fracture angulation (°), fracture displacement (mm) and direction (anterior, posterior). The fractures were stratified as stable (displacement <4.5mm, angulation <15°) or unstable. Stable fractures were treated with a non-rigid immobilization, unstable fractures surgically.

Result: We encountered 65 stable and 30 unstable fractures. For stable fractures the average dens angulation was 13° and 1.8mm displaced. The observed non-union rate was 25% of which 2 patients underwent a secondary posterior transarticular fixation. The other 14 patients had either stable nonunions or could not undergo a surgery. Surgical intervention was performed in 30 patients with an average dens angulation of 21° and 5.2mm displacement. A posterior C1-C2 fusion was carried out in 24 patients (80%), a C0 onto C4 stabilization in 3 (10%) and an anterior odontoid screw fixation in 3 patients (10%). For direct anterior screw fixation there was 1 non-union, which was revised, for posterior C1/2 fixation the union rate was 100%.

Conclusion: The need for surgical intervention in patients greater than 75 years is a fracture dislocation >4.5mm and angulation of >15°, posterior C1/2 fixation is highly successful and safe. Stable fractures can be successfully treated with non-rigid immobilization.