gms | German Medical Science

Objective: The demographic change in the population leads to a rising number of patients presenting with fractures of the cervical spine, especially C2, due to falls. With an increase of co-morbidities in these elder patients the risk for postoperative complications is increased likewise. Thus, an alternative strategy for fracture treatment should be taken into account wherever possible. Conservative management of dens fractures in the elderly is still a subject of great controversy despite numerous studies on this topic. The aim of this study was to estimate the success rate of osseous consolidation of the fracture with conservative treatment by wearing a semirigid collar or halo vest without further surgical intervention.

Method: We analysed retrospectivly the medical records and CT scan of the cervical spine (if available) of 227 patients with dens fractures (age 70,38 years ± 21,84 years) who were admitted to our Department between January 1990 and September 2014. 161 patients were submitted to surgery as treatment of choice. In 66 patients a conservative management was with external immobilisation indicated when there was there was no dislocation of the fracture an no neurological deficits were present. Fractures were identified by CT scan of the cervical spine and classified according to the Anderson-D'Alonzo classification.

Results: 66 patients were treated conservatively using a Philadelphia collar (47), a Henßge collar (3), a halo vest (13), a Somi brace (1), a Basco collar (1) or a cast (1). The conservative treatment was deemed successful by bony consolidation of the fracture in follow-up CT scans in 44 patients (77,2 % ). In 13 patients external immobilisation failed to achieve primary stability and, thus, these patients were submitted to consequent surgery 9 patients were lost to follow-up despite intense inquiries.

Conclusions: From our data it can be concluded that patients with non-dislocated fractures of the axis and without neurological deficits will have a 77% chance with a conservative management to gain a bony consolidation of their fracture. Therefore, a conservative treatment could be a reasonable option to treat elderly patients under certain circumstances. Yet, it has to be assured that the external immobilisation is worn at all times to prevent unintended dislocation of the fracture.