Abstract
BackgroundAlong with the growing geriatric population, the number of odontoid fractures is steadily increasing. However, the effectiveness of immobilizing geriatric odontoid fractures using a cervical collar has been questioned. The aim of the present study is to analyze the physiological and pathological motion in odontoid fractures and to assess limitation of motion in the cervical spine when applying a cervical collar.MethodsMotion analysis was performed with wireless motion tracker on unfixed geriatric human cadavers. First, a new geriatric type II odontoid fracture model was developed. In this model, the type II odontoid fracture is operated via a transoral approach. The physiological and pathological flexion and lateral bending of the cervical spine resulting from this procedure was measured. The resulting motion after external stabilization using a cervical collar was analyzed.ResultsThe new geriatric type II odontoid fracture model was successfully established using seven unfixed human cadavers. The pathological flexion of the cervical spine was significantly increased compared to the physiological flexion (p = 0.027). Furthermore, the flexion was significantly reduced when a cervical collar was applied. In case of flexion the mean remaining motion was significantly reduced (p = 0.0017) from 41° to 14°. For lateral bending the mean remaining motion was significantly reduced (p = 0.0137) from 48° to 18°.ConclusionsIn case of type II odontoid fracture, flexion and lateral bending of the cervical spine are increased due to spinal instability. Thus, if an odontoid fracture is suspected in geriatric patients, the application of a cervical collar should always be considered since external stabilization can significantly reduce flexion and lateral bending.
Highlights
In the geriatric population, the most common fractures of the cervical spine are odontoid fractures, accounting for more than 50% of total cervical spine fractures [1, 2]
The pathological flexion of the cervical spine was significantly increased compared to the physiological flexion (p = 0.027)
If an odontoid fracture is suspected in geriatric patients, the application of a cervical collar should always be considered since external stabilization can significantly reduce flexion and lateral bending
Summary
The most common fractures of the cervical spine are odontoid fractures, accounting for more than 50% of total cervical spine fractures [1, 2]. Unlike odontoid fractures in young patients, these injuries in the geriatric population are mainly caused by minor trauma and falls at home [7,8,9]. These low-impact trauma mechanisms are one factor that may explain why these patients are often under-triaged by Emergency Medical Service personnel (EMS) at the scene of an accident as well as in the admitted hospital [10, 11]. In contrast to young patients, a typical geriatric facial structure is described [12, 13] It is unclear whether this change in facial structure has an influence on the remaining motion after external immobilization of the cervical spine. The aim of the present study is to analyze the physiological and pathological motion in odontoid fractures and to assess limitation of motion in the cervical spine when applying a cervical collar
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