Odontoid fracture type and angulation affect nonunion risk, but comminution and displacement do not: A propensity score matched analysis of fracture morphology

Odontoid fractures disproportionately affect older patients who have high surgical risk, but also high rates of fracture nonunion. To guide surgical decision-making, we quantified the effect of fracture morphology on nonunion among nonoperatively managed, traumatic, isolated odontoid fractures. We e...

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Published in:Clinical neurology and neurosurgery 2023-08, Vol.231, p.107855-107855, Article 107855
Main Authors: Cloney, Michael, Thirunavu, Vineeth, Roumeliotis, Anastasios, Azad, Hooman, Shlobin, Nathan, Swong, Kevin, El Tecle, Najib, Dahdaleh, Nader S.
Format: Article
Language:English
Subjects:
Age
Axis
Bone healing
Confidence intervals
Decision making
Dens
Fracture
Fractures, Bone
Fractures, Ununited - diagnostic imaging
Fractures, Ununited - epidemiology
Humans
Morphology
Neurology
Nonunion
Odontoid
Odontoid Process - surgery
Osteoporosis
Patients
Propensity Score
Regression analysis
Retrospective Studies
Spinal Fractures - surgery
Spinal Fractures - therapy
Spine
Treatment Outcome
Variables
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Summary:Odontoid fractures disproportionately affect older patients who have high surgical risk, but also high rates of fracture nonunion. To guide surgical decision-making, we quantified the effect of fracture morphology on nonunion among nonoperatively managed, traumatic, isolated odontoid fractures. We examined all patients with isolated odontoid fractures treated nonoperatively at our institution between 2010 and 2019. Multivariable regression and propensity score matching were used to quantify the effect of fracture type, angulation, comminution, and displacement on bony healing by 26 weeks from injury. 303 consecutive traumatic odontoid fracture patients were identified, of whom 163 (53.8 %) had isolated fractures that were managed nonoperatively. Selection for nonoperative management was more likely with older age (OR=1.31 [1.09, 1.58], p = 0.004), and less likely with higher fracture angle (OR=0.70 [0.55, 0.89], p = 0.004), or higher presenting Nurick scores (OR=0.77 [0.62, 0.94], p = 0.011). Factors associated with nonunion at 26 weeks were fracture angle (OR=5.11 [1.43, 18.26], p = 0.012) and Anderson-D’Alonzo Type II morphology (OR=5.79 [1.88, 17.83], p = 0.002). Propensity score matching to assess the effect of type II fracture, fracture angulation> 10o, displacement≥ 3 mm, and comminution all yielded balanced models (Rubin's B
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2023.107855