A. X. Samayoa1, K. Foley1, A. Konopitski1, C. Hodge1, J. Yuschak1, T. Vu1, R. Shadis1 1Abington Jefferson Health,Surgery,Abington, PA, USA
Introduction:
Cervical spine fractures are debilitating injuries. Unstable C-2 fractures in the elderly are especially serious injuries that pose difficult management and disposition challenges. In our institution we describe the prevalence of these injuries in the extremes of the elderly.
Methods:
A single institution retrospective review from 1-2004 to 12-2014 was conducted on patients sustaining C-2 fractures. They were then identified as stable or unstable and subdivided in two groups: A [65-79 yrs] and B [ ≥80 yrs ].
Results:
247 patients had C-2 fractures, 151 were unstable: 35/74 (47%) in group A and 116/173 (67%) in group B. Unstable C-2 fractures were more common in group B [p=0.003]. The most common mechanisms was falling, 25 [71%] in group A and 96 [83%] in group B. Falling from standing height or less [standing, seating, from bed] was higher in group B [p=0.018]. Few patients were treated operatively 23% (group A) and 13% (group B) without difference between groups [p=0.181], however the group B was significantly less likely to be discharged home [p=0.013]. No difference was found in concomitant intracranial bleeding, ICU admission, length of stay, need for feeding tube or in hospital death.
Conclusion:
Unstable C-2 fractures are more prevalent in patients 80 yrs and over [group B]. Additionally, falls from standing height [or less] are more common in this group. We found no significant difference in the two age groups that warranted surgical intervention. As expected, younger patients were more likely to be discharge home. We feel that this study encompasses some important points on unstable C-2 fractures in the elderly and a larger multicenter study would further validate these findings.
