A Systematic Review of Surgical Intervention versus Conservative Management in Treatment of Type II Odontoid Fracture in the Elderly
Authors: Saoud Khaled Mohamed Fathy , Sabry Hatem Adel Saied , Ibrahim Aly Ibrahim Soliman , Ahmed Zeyad Safwat Hegazy 
Published: August 2023

Background
Odontoid fractures are the most common cervical spine fracture in elderly patients. It is clear that identifying an evidence-based treatment algorithm for odontoid fractures in these patients is paramount. Although patients of all ages with type I and III fractures are routinely treated in a cervical orthosis, the optimal treatment for type II geriatric odontoid fractures has been the topic of substantial debate in recent years.

Aim of the Work
To compare the outcome of conservative external immobilization versus surgical fusion in terms of morbidity, mortality, fusion rates and quality of life estimates in treatment of odontoid fracture type II in elderly. This will be done through a systematic review of literature addressing this research question.

Patients and Methods
In this Review, the authors are aiming at the analysis of the collective outcomes from studies comparing surgical and non-surgical management in elderly patients with odontoid fracture type II. Primary objective is to compare between the two groups in terms of mortality within the first year of injury and major and minor complications. Secondary objective is to evaluate the rate of fusion within a follow up period of 2-3 years.

Results
From the 17 included studies, six studies with total number of patients of 235 reported patients complicated with pneumonia with 9 (7.7%) patients in the non-surgically managed group and 12 (10.2%) patients, which was statistically insignificant with p-value 0.506 (NS). Only 2 studies reported patients with postoperative DVT with total number of patients of 109 from which 69 managed surgically and postoperative 3(4.3%) complicated with DVT which was statistically insignificant with P-value 0.182 (NS). Four studies with total number of 219 patients reported the patients complicated with Myocardial infarction, with 5 (4.9%) patients in the non-surgically managed group and 7 (6.0%) patients in the surgically managed group which was statistically insignificant with P-value 0.701 (NS), Three studies with total number of 177 patients reported the patients complicated with pressure ulcers in the non-surgically managed group 2 (2.1%) and wound infection in the surgically managed group 3 (3.7%) which is statistically insignificant with P value 0.517 (NS). Four studies with total number of patients of 175, reported minor complications such as blood transfusion, swallowing problems, UTI, in the non surgically managed group 10 (9.1%) and in the surgically managed group 16 (24.6%) which is statistically significant with P value 0.005 (HS).

Conclusion
Type II odontoid fractures in elderly patients are a common injury, and the mortality rate is substantial in patients treated with or without surgery. However, patients undergoing surgical treatment appear to have a decreased risk of mortality at least in the first year of trauma without an increase in the risk of significant complications, with higher rate of fusion.