Background The optimal treatment for odontoid fractures in older people remains debated. Odontoid fractures are increasingly relevant to clinical practice due to ageing of the population. Methods An international prospective comparative study was conducted in fifteen European centres, involving patients aged ≥55 years with type II/III odontoid fractures. The surgeon and patient jointly decided on the applied treatment. Surgical and conservative treatments were compared. Primary outcomes were Neck Disability Index (NDI) improvement, fracture union and stability at 52 weeks. Secondary outcomes were Visual Analogue Scale neck pain, Likert patient-perceived recovery and EuroQol-5D-3L at 52 weeks. Subgroup analyses considered age, type II and displaced fractures. Multivariable regression analyses adjusted for age, gender and fracture characteristics. Results The study included 276 patients, of which 144 (52%) were treated surgically and 132 (48%) conservatively (mean (SD) age 77.3 (9.1) vs. 76.6 (9.7), P = 0.56). NDI improvement was largely similar between surgical and conservative treatments (mean (SE) −11 (2.4) vs. −14 (1.8), P = 0.08), as were union (86% vs. 78%, aOR 2.3, 95% CI 0.97–5.7) and stability (99% vs. 98%, aOR NA). NDI improvement did not differ between patients with union and persistent non-union (mean (SE) −13 (2.0) vs. −12 (2.8), P = 0.78). There was no difference for any of the secondary outcomes or subgroups. Conclusions Clinical outcome and fracture healing at 52 weeks were similar between treatments. Clinical outcome and fracture union were not associated. Treatments should prioritize favourable clinical over radiological outcomes.

中文翻译：

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老年人齿状突骨折的手术与保守治疗：一项国际前瞻性比较研究


背景 老年人齿状突骨折的最佳治疗方法仍存在争议。由于人口老龄化，齿状骨折与临床实践的关系越来越密切。方法 在 15 个欧洲中心进行了一项国际前瞻性比较研究，涉及 ≥55 岁的 II/III 型齿状突骨折患者。外科医生和患者共同决定采用的治疗方法。比较了手术治疗和保守治疗。主要结局是 52 周时颈部残疾指数 （NDI） 改善、骨折愈合和稳定性。次要结局是 52 周时的视觉模拟量表颈部疼痛、李克特患者感知恢复和 EuroQol-5D-3L。亚组分析考虑了年龄、II 型和移位性骨折。根据年龄、性别和骨折特征调整的多变量回归分析。结果 该研究包括 276 名患者，其中 144 名 （52%） 接受手术治疗，132 名 （48%） 接受保守治疗 （平均 （SD） 年龄 77.3 （9.1） vs. 76.6 （9.7），P = 0.56）。手术治疗和保守治疗之间的 NDI 改善基本相似 （平均值 （SE） -11 （2.4） vs. -14 （1.8），P = 0.08），愈合 （86% vs. 78%，aOR 2.3,95% CI 0.97-5.7） 和稳定性 （99% vs. 98%，aOR NA）。愈合和持续性不愈合患者之间的 NDI 改善没有差异 （平均值 （SE） -13 （2.0） vs. -12 （2.8），P = 0.78）。任何次要结局或亚组均无差异。结论 不同治疗之间的临床结局和 52 周骨折愈合相似。临床结局和骨折愈合无关。治疗应优先考虑良好的临床结局，而不是放射学结局。