Early mortality and morbidity following a type II odontoid fracture in the elderly Hassaan Q. Sheikh * , Michael Athanassacopoulos, Arpan B. Doshi, Lee Breakwell, Ashley Cole, Antony Louis Rex Michael, Neil Chiverton Sheffield Teaching Hospitals, Trauma and Orthopaedic, Herries Road, Sheffield, S5 7AU, UK article info Article history: Received 15 December 2017 Received in revised form 13 February 2018 Accepted 6 March 2018 Available online xxx Keywords: Odontoid fracture Elderly Mortality Non-operative management Complications abstract Background: We aimed to analyse the rates of early and causes of death in patients aged over 65 years with a type II odontoid fracture. Methods: A consecutive series of 93 patients with a type II fracture of the odontoid process was retrospectively identified. Data collected included patient demographics, co- morbidities, associated injuries, neurological injury, date of death and cause of death. Mean patient age was 81. Five patients (5%) were treated operatively while the rest were treated in a hard cervical collar. Five patients (5%) had an incomplete cervical cord injury secondary to the fracture. Results: The rate of mortality at 30 days was 10% (9 patients) and at 90 days it was 16% (15 patients). Following multivariate analysis, the factors found to significantly increase the risk of 30-day mortality included increasing age, increasing injury severity score and leukaemia. Following univariate analysis the only factor found to increase the risk of 90- day mortality was advancing age. The commonest causes of death were pneumonia and ischaemic coronary disease. Conclusion: Our results suggest that this patient cohort is frail and at risk of early mortality. We suggest that their inpatient care be provided in close conjunction with elderly care physicians. Crown Copyright © 2018 Published by Elsevier Ltd on behalf of Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. All rights reserved. Introduction Odontoid fractures are the commonest injury of the cervical spine in the elderly. 1 In the elderly, a type II fracture (as classified by Anderson and D'Alonzo) 2 is the commonest odontoid fracture. Whilst there is no unified definition of ‘elderly’ within published spine literature, most authors focussing on this injury include patients aged 65 years and above as elderly. 3e5 Due to their advanced age, these patients usually present with associated co-morbidities. 6 Treatment of this injury in the elderly cohort has always been controversial, with some centres advocating fixation of the injury in order to mobilise the cervical spine early, 7 whilst others advocate non operative management in a hard cervical orthosis to counter * Corresponding author. E-mail address: hqsheikh@doctors.org.uk (H.Q. Sheikh). Available online at www.sciencedirect.com ScienceDirect The Surgeon, Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland www.thesurgeon.net the surgeon xxx (2018) 1 e5 Please cite this article in press as: Sheikh HQ, et al., Early mortality and morbidity following a type II odontoid fracture in the elderly, The Surgeon (2018), https://doi.org/10.1016/j.surge.2018.03.007 https://doi.org/10.1016/j.surge.2018.03.007 1479-666X/Crown Copyright © 2018 Published by Elsevier Ltd on behalf of Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. All rights reserved.