{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:07:22Z","timestamp":1789718842613,"version":"4.0.1"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,10,7]],"date-time":"2013-10-07T00:00:00Z","timestamp":1381104000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Non\u2010surgical immobilization strategies for type 2 odontoid fractures vary considerably, with some surgeons preferring rigid collars, halothoracic bracing or the <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>inerva brace. Choice of device should be informed by the effectiveness in achieving union, whilst minimizing mortality and complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Perform a systematic review evaluating the efficacy of non\u2010surgical interventions for type 2 odontoid fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OvidSP<\/jats:styled-content>), <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OvidSP<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>he <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ochrane <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>ibrary, <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>linical<jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>rials.gov, <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>urrent <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ontrolled <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>rials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a systematic review of studies directly comparing the halothoracic brace and cervical collars or the <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>inerva brace for union, mortality and complications. Studies were appraised for quality and bias, and results were pooled for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our search identified 1794 citations, 13 of which met inclusion criteria. There were no randomized or prospective studies. All studies were small, retrospective and observational. Our results demonstrate a greater likelihood of developing stable union (osseous and fibrous); relative risk (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) 1.27 (95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 1.03 to 1.57; <jats:italic>P<\/jats:italic> = 0.03); and airway complications; <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 7.52 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.39 to 40.83; <jats:italic>P<\/jats:italic> = 0.02) with halothoracic bracing compared with cervical collar. In patients &gt;65, there was a greater risk of airway complications; <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 7.50 (0.96\u201358.36; <jats:italic>P<\/jats:italic> = 0.05). No other significant differences were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Evidence to support selection of non\u2010surgical immobilization in type 2 odontoid fractures is poor. Osseous union has traditionally been the benchmark for \u2018successful\u2019 treatment; however, evidence of association between union and improved outcomes is lacking. We highlight the need for a randomized study to promote evidence\u2010based decision\u2010making in the non\u2010surgical management of this injury.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.12401","type":"journal-article","created":{"date-parts":[[2013,10,12]],"date-time":"2013-10-12T02:10:53Z","timestamp":1381543853000},"page":"320-325","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Non\u2010surgical interventions for the management of type 2 dens fractures: a systematic review"],"prefix":"10.1111","volume":"84","author":[{"given":"David","family":"Sime","sequence":"first","affiliation":[{"name":"National Trauma Research Institute The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Department of Orthopaedic Surgery The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Pitt","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loyal","family":"Pattuwage","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Tee","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"},{"name":"Department of Neurosurgery The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Liew","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Gruen","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Trauma Service The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,10,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1989.71.5.0642"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197456080-00017"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-201007000-00001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1302\/0301-620X.64B4.7096414","article-title":"Odontoid fractures. A rational approach to treatment","volume":"64","author":"Ryan M","year":"1982","journal-title":"J. Bone Joint Surg. Br."},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-003-0531-1"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31818d5407"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-198112000-00004"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2003.11.0527"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005860050188"},{"key":"e_1_2_9_11_1","unstructured":"WellsGA SheaB O'ConnellDet\u2009al.The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta\u2010Analyses. University of Ottawa Department of Epidemiology and Community Medicine University of Ottawa Canada. [Cited 20 Mar 2012.] Available from URL:http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/nosgen.pdf"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)93004-K"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_9_14_1","first-page":"17","article-title":"The nonsurgical treatment of fractures of the dens epistrophei","volume":"76","author":"Bettini N","year":"1991","journal-title":"Chir. Organi Mov."},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1391-0"},{"key":"e_1_2_9_16_1","first-page":"45","article-title":"An evaluation of the results of two non\u2010surgical methods in the treatment of fractures of the odontoid process","volume":"85","author":"Della Torre P","year":"2000","journal-title":"Chir. Organi Mov."},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1993.78.1.0032"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198708000-00013"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2000.8.6.8"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2010.05586.x"},{"key":"e_1_2_9_21_1","first-page":"450","article-title":"Nonoperative management of types II and III odontoid fractures: the Philadelphia collar versus the halo vest","volume":"38","author":"Polin R","year":"1996","journal-title":"Neurosurgery"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181e8e77c"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0b013e318163570b"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198404000-00001"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.86B8.14839"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2004.09.014"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.80B3.8371"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199410150-00009"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-002-0083-2"},{"key":"e_1_2_9_30_1","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S0030-5898(20)32209-4","article-title":"Fractures of the odontoid: a laboratory and clinical study of mechanisms","volume":"9","author":"Mouradian W","year":"1978","journal-title":"Orthop. Clin. North. Am."},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000174671.07664.7c"},{"key":"e_1_2_9_32_1","first-page":"1697","article-title":"Health services research: reporting on studies using secondary data sources","volume":"155","author":"Huston P","year":"1996","journal-title":"Can. Med. Assoc. J."},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31819c40f5"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fans.12401","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.12401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T03:59:07Z","timestamp":1696478347000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.12401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,7]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,5]]}},"alternative-id":["10.1111\/ans.12401"],"URL":"https:\/\/doi.org\/10.1111\/ans.12401","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10,7]]},"assertion":[{"value":"2013-08-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-10-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}