Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 28. Clinical and radiological outcome of odontoid fractures treated with soft collar immobilization

Abstract

BACKGROUND CONTEXT Nonoperative treatment of odontoid fractures can be achieved with non-rigid cervical immobilization (either hard or soft cervical collars). Hard collars are commonly used but are associated with a risk of skin breakdown. Soft collars may reduce this risk but raise concerns that they do not provide sufficient immobilization for these injuries. PURPOSE To identify the clinical and radiological outcomes of odontoid fractures treated with soft collar immobilization. STUDY DESIGN/SETTING Tertiary level spinal injuries unit retrospective review of cases. PATIENT SAMPLE Consecutive patients presenting to a tertiary level spinal injuries unit over a five-year period (July 2010 to July 2015) with nonoperatively treated odontoid fractures. OUTCOME MEASURES Radiological and clinical outcome measures. METHODS Consecutive patients presenting to a tertiary level spinal injuries unit over a five-year period (July 2010 to July 2015) with nonoperatively treated odontoid fractures. All patients receiving external non-rigid immobilization were treated with soft cervical collars. RESULTS Fifty-four patients (34 female, 20 male). Mean age 77 years (range 29-104). Mechanism of injury was fall (37), MVA (13), syncope (2) and blunt trauma (2). There were 28 type 3 fractures, 23 type 2 fractures and 3 type 1 fractures (Anderson and D'Alonzo classification). At presentation mean angulation was 14.6° (range 0-50°) and mean displacement was 1.9mm (range 0mm–11mm). Two failed nonoperative treatment and required fixation (one at 2 weeks and one at 4 months following injury). Radiological union was demonstrated in 25% of cases. At final follow-up, mean angulation was 16.9° (range 0-63°) and mean displacement was 2.6 mm (range 0 mm–16 mm). Overall mortality was 18.5%. There were no cases of skin breakdown. CONCLUSIONS Clinical and radiological outcomes for soft collars are comparable to those reported in the literature for hard collars. Soft collars are a safe and effective alternative to hard collars for the treatment of odontoid fractures and reduce the risk of skin breakdown. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.