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Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process
KOIVIKKO MP; KIURU MJ; KOSKINEN SK
J BONE JOINT SURG BR , 2004, vol. 86, n° 8, p. 1146-1151 Doc n°: 116295 Localisation : Bibliothèque Universitaire de Médecine de Nancy Descripteurs : CC4 - TRAUMATISMES - RACHIS CERVICAL In type-II fractures of the odontoid process, the treatment is either conservative in a halo vest or primary surgical stabilisation. Since nonunion, requiring prolonged immobilisation or late surgery, is common in patients treated in a halo vest, the identification of those in whom this treatment is likely to fail is important. We reviewed the data of 69 patients with acute type-II fractures of the odontoid process treated in a halo vest. The mean follow-up was 12 months. Conservative treatment was successful, resulting in bony union in 32 (46%) patients. Anterior dislocation, gender and age were unrelated to nonunion. However, nonunion did correlate with a fracture gap (>1 mm), posterior displacement (> 5 mm), delayed start of treatment (> 4 days) and posterior redisplacement (> 2 mm). We conclude that patients presenting with these risk factors are unlikely to achieve bony union by treatment in a halo vest. They deserve careful attention during the follow-up period and should also be considered as candidates for primary surgical stabilisation. Langue : ANGLAIS |
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