OTA 2006 Posters

Scientific Poster #99 Geriatrics

Mortality of Halo-Vest Immobilization for Geriatric Odontoid Fractures
Christopher A. Heck, MD (n); William O. Shaffer, MD (n);
Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA

Background/Purpose: Odontoid process fractures are the most common cervical spine fracture in the elderly. However, the method of treatment in this age group remains debatable due to anecdotal reports of increased mortality associated with the use of a halo-vest orthosis in this patient population. This retrospective study describes the mortality of patients 65 years or older who sustained an odontoid fracture and were treated nonoperatively at our institution.

Methods: Between 1996 and 2005, 41 patients over the age of 65 years of age with an odontoid fracture of the axis were treated nonoperatively with either a hard cervical orthosis or a halo-vest orthosis. Medical records were evaluated for age at injury, mechanism of injury, odontoid fracture type, method of treatment, neurologic status at presentation, days spent in the hospital and intensive care unit (ICU), smoking history, concomitant injuries, and medical comorbidities. The last date that the patient was known to be alive was confirmed via a phone conversation with the patient or family member, an appointment with any medical specialty at our institution, or the state death certificate.

Results: Of the 41 odontoid fractures, 26 were treated in a hard cervical or cervicothoracic orthosis and 15 were immobilized in a halo-vest orthosis. The two treatment groups were statistically similar with respect to demographic and premorbid conditions. Eleven (73%) patients treated with a halo were injured as a result of a fall, whereas 16 (62%) patients treated with a hard cervical orthosis were injured in a motor vehicle accident (P = 0.05). Also, three (20%) of halo patients presented with a neurologic deficit, whereas no patients treated in a hard cervical orthosis presented with a deficit (P = 0.04). The mortality rate for both a hard cervical orthosis and a halo-vest orthosis was 27% (P = 0.99) at 3 months after injury and increased to 38% and 53% (P = 0.51), respectively, at 18 months after injury. For those patients who survived the first 3 months after injury, the halo-vest orthosis had an 83% survival rate.

Conclusions/Significance: The use of halo-vest immobilization for geriatric odontoid fractures has similar mortality rates up to 18 months after the injury when compared with hard cervical orthotics. Therefore, halo-vest immobilization for odontoid fractures is well tolerated in the geriatric population and should be used when clinically and radiographically indicated.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.