{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T11:37:53Z","timestamp":1794051473587,"version":"4.8.0"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,5,21]],"date-time":"2022-05-21T00:00:00Z","timestamp":1653091200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,21]],"date-time":"2022-05-21T00:00:00Z","timestamp":1653091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100011852","name":"Paracelsus Medical University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011852","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>We carried out a retrospective cohort study to differentiate geriatric odontoid fractures into stable and unstable and correlated it with fracture fusion rates. Results are based on the literature and on our own experience. The authors propose that the simple Anderson and D\u2019Alonzo classification may not be sufficient for geriatric patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>There were 89 patients\u2009\u2265\u200965\u00a0years who presented at our institution with type II and III odontoid fractures from 2003 until 2017 and were included in this study. Each patient was categorized with CT scans to evaluate the type of fracture, fracture gap (mm), fracture angulation (\u00b0), fracture displacement (mm) and direction (ventral, dorsal). Fractures were categorized as stable [SF] or unstable [UF] distinguished by the parameters of its angulation (&lt;\u2009\/\u2009&gt;\u200911\u00b0) and displacement (&lt;\u2009\/\u2009&gt;\u20095\u00a0mm) with a follow-up time of 6\u00a0months.<\/jats:p>\n                <jats:p>SFs were treated with a semi-rigid immobilization for 6\u00a0weeks, UFs surgically\u2014preferably with a C1\u2013C2 posterior fusion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The classification into SFs and UFs was significant for its angulation (<jats:italic>P<\/jats:italic>\u2009=\u20090.0006) and displacement (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). SF group (<jats:italic>n<\/jats:italic>\u2009=\u200957): A primary stable union was observed in 35, a stable non-union in 10, and an unstable non-union in 8 patients of which 4 were treated with a C1\/2 fixation. The overall consolidation rate was 79%. UF group (<jats:italic>n<\/jats:italic>\u2009=\u200932): A posterior C1\u2013C2 fusion was carried out in 23 patients, a C0 onto C4 stabilization in 7 and an anterior odontoid screw fixation in 2. The union rate was 100%. Twenty-one type II SFs (91%) consolidated with a nonoperative management (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). A primary non-union occurred more often in type II than in type III fractures (<jats:italic>P<\/jats:italic>\u2009=\u20090.0023). There was no significant difference in the 30-day overall case fatality (<jats:italic>P<\/jats:italic>\u2009=\u20090.3786).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>To separate dens fractures into SFs and UFs is feasible. For SFs, semi-rigid immobilization provides a high consolidation rate. Stable non-unions are acceptable, and the authors suggest a posterior transarticular C1\u2013C2 fixation as the preferred surgical treatment for UFs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Level III.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-022-01985-0","type":"journal-article","created":{"date-parts":[[2022,5,21]],"date-time":"2022-05-21T18:06:49Z","timestamp":1653156409000},"page":"2967-2976","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Reevaluation of a classification system: stable and unstable odontoid fractures in geriatric patients\u2014a radiological outcome measurement"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8352-7371","authenticated-orcid":false,"given":"Amelie","family":"Deluca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Wichlas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Deininger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Traweger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernst J.","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,21]]},"reference":[{"key":"1985_CR1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/978-88-470-5232-1_6","volume-title":"The axis vertebra","author":"DS Korres","year":"2013","unstructured":"Korres DS. Fractures of the odontoid process. In: Korres DS, editor. The axis vertebra. Rome: Springer; 2013. p. 45\u20139."},{"key":"1985_CR2","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/0020-1383(92)90123-A","volume":"23","author":"MD Ryan","year":"2002","unstructured":"Ryan MD, Henderson JJ. The epidemiology of fractures and fracture-dislocation of the cervical spine. Injury. 2002;23:38\u201340.","journal-title":"Injury"},{"key":"1985_CR3","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.spinee.2004.09.014","volume":"5","author":"JN Gauer","year":"2005","unstructured":"Gauer JN, Shafi B, Hilibrand AS, Harrop J, Kwon BK, Beiner JM, Albert TJ, Fehlings MG, Vaccaro AR. Proposal of a modified, treatment-oriented classification of odontoid fractures. 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