NS03 RISK FACTORS FOR NON‐UNION IN THE NON‐OPERATIVE MANAGEMENT OF TYPE II DENS FRACTURES

Abstract

Purpose: Despite the publication of numerous studies, controversy regarding the non‐operative treatment of type II dens fractures remains. The halo‐thoracic vest (HTV) and cervical collar are the most commonly used devices. We sought to compare the outcomes of patients managed with these devices in terms of risk factors for non‐union and the rate of associated complications.Methodology: This study was a retrospective review of adult patients with type II dens fractures treated non‐operatively at a level 1 trauma centre between 2001 and 2007. Patient records and imaging studies were reviewed. Union was defined as stable fibrous union or bony union, measured at 3 months. A p‐value of <0.05 was considered statistically significant.Results: Sixty‐seven patients were included. Thirty‐five patients were treated using a HTV and 32 with a collar. The proportion of patients with stable union at 3 months was 60% for the HTV group versus 35% for the cervical collar group (p = 0.10). Non‐union was found to be associated with increased time in HTV or collar (p = 0.011) and a mechanism of injury involving a low fall (p = 0.008). Clinically significant complications of HTV had a ten‐fold greater prevalence than those of the collar (60% versus 6%).Conclusion: We were unable to demonstrate any clear advantage or disadvantage of either device. Further investigation of mortality would be beneficial, particularly in the patient group injured with a mechanism involving a low fall which tends to include more elderly patients.