gms | German Medical Science

To evaluate the surgical results, the outcome and the complication rate in a series of geriatric patients with unstable fractures of C2. Are these results good enough to justify the indication to operate on such patients?

Retrospective analysis of clinical and radiological data, of a series of 18 patients, which were operated in our institution in a 4 year period (2000-2003). The diagnosis of unstable C2 fracture was the indication of operation.

Mean age of this group of patients was 81 years, with a range between 71-91 years. The woman to men ratio is 2:1. 12 patients were admitted without motor deficits. We applied two surgical methods. 10 patients were operated by a ventral approach according to the Knöriger screw fixation technique and 8 of them by a dorsal approach applying the Magerl technique. No major complications related to the surgery were observed. We re-operated on a patient due to screw dislocation one month after a dorsal C1/C2 fixation. In our series we had 4 deaths in the early postoperative period (10-15 days post-OP), 2 of these were patients with very bad preoperative condition. A patient underwent a stroke 8 days after the operation despite full mobilisation at the first post-OP day.

With operative stabilisation of C2 fractures we achieve an early mobilisation of the patients, without an external orthosis. The ventral screw fixation, which is a minimally invasive operation, is sufficient in the most of the Anderson and D' Alonzo type II fractures of the odontoid process. The dorsal C1/C2 stabilisation is a more extended operation and predisposes a good condition of the patient.