Older patients with odontoid process and cervical spine fractures: evaluating clinical risk factors, clinical pathways and treatment to prevent further fracture.
Date: 26 July 2018
University of Exeter
MbyRes in Medical Studies
INTRODUCTION The most common site of cervical spine fracture in the elderly is the odontoid process. These fractures result predominantly from ground level falls. Osteoporosis has been identified as an important predisposing risk factor. This study aimed to evaluate the management of older patients with cervical spine fractures and ...
INTRODUCTION The most common site of cervical spine fracture in the elderly is the odontoid process. These fractures result predominantly from ground level falls. Osteoporosis has been identified as an important predisposing risk factor. This study aimed to evaluate the management of older patients with cervical spine fractures and identify opportunities to reduce fracture rates. METHODS A service evaluation was undertaken utilising a retrospective review of electronic hospital records at the Royal Devon and Exeter hospital for patients aged 50 years and over who sustained a cervical spine fracture over a four year period. Patients were identified from CT cervical spine reports positive for fracture. RESULTS 85 patients (x̄ age: 77.2 years, σ ±12.7) were identified. 61.2% sustained fractures from a ground level fall. Prior to cervical spine fracture 41.2% had sustained at least one previous fracture of any bone, 11.8% had a dual-energy X-ray absorptiometry (DXA) scan and 9.4% had bisphosphonate use recorded. One year following cervical spine fracture, a further five people had a DXA and one more person was taking a bisphosphonate. Five people attended the hospital with a fracture within a year of the c-spine fracture, four of which were neck of femur fractures. Mortality at three months and one year were 11.8% and 20.8% respectively. There was no clearly superior management strategy between surgical or non-surgical management. There was a high prevalence of cervical spondylosis but no association between severity and any characteristics of the injury. Projection radiography was carried out before CT in 71.3% of patients. Time spent in A&E was under four hours in 38.2% of visits. Median initial inpatient stay length was seven nights. Re-admission rate at 30 days was 15.9%. Patients were discharged from an inpatient stay to their usual place of residence in 78.1% of cases. CONCLUSION Mortality rates are similar to those published in other studies. Guidelines for initial imaging of cervical spine injuries are not consistently being followed. Fracture prevention is not an integrated part of c-spine fracture care despite their association with osteoporosis in the elderly. Implementation of a Fracture Liaison Service is recommended.
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