Non-operative treatment of odontoid peg fractures

Abstract

OBJECTIVE: The aim of this study was to review the results of non-operative treatment of odontoid fractures in Steve Biko Academic Hospital, Pretoria. METHODS: Records for all patients treated for odontoid fractures from 2008 to 2018 were reviewed. 28 patients met the study criteria. Demographic data, mechanism of injury, associated injuries, neurology, imaging studies and treatment were reviewed. RESULTS: There were 23 males and 5 females. The average age at presentation was 39.5 years. 25 patients were injured in road traffic accidents. Associated injuries were present in 21 patients, mostly involving the spine and head. 18 fractures were classified as Type II and 15 as Type III. Fracture comminution (5), angulation (6) and translation (10) were noted. Primarily treatment modalities were cones callipers, Philadelphia collar or halo vest. Fracture union was assessed radiologically at 3, 6 and 9 months. Type II and III fractures had high union rates at 6 and 9 months. Significantly displaced fractures had a statistically lower union rate (p = 0.0285) at 6 months. CONCLUSION: Minimally displaced odontoid Type II and III fractures can be effectively treated non-operatively in young adults. Extent of fracture displacement is the single important factor in non-union rate.