{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T03:46:17Z","timestamp":1780112777855,"version":"3.54.0"},"reference-count":23,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"9","license":[{"start":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T00:00:00Z","timestamp":1472688000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p> We performed a retrospective, comparative study of elderly patients with an increased risk from anaesthesia who had undergone either anterior screw fixation (ASF) or halo vest immobilisation (HVI) for a type II odontoid fracture. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> A total of 80 patients aged 65 years or more who had undergone either ASF or HVI for a type II odontoid fracture between 1988 and 2013 were reviewed. There were 47 women and 33 men with a mean age of 73 (65 to 96; standard deviation 7). All had an American Society of Anesthesiologists score of 2 or more. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Patients who underwent ASF had a significantly better outcome than those who were treated by HVI. There was a rate of nonunion of 10% after ASF and 23% after HVI. Failure of reduction or fixation occurred in 11 patients (15%) but there was no significant difference between the two groups. Mortality rates were also similar: 9% (n = 3) after ASF and 8% (n = 4) after HVI. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> We conclude that ASF is the preferred method of treatment in this group of elderly patients, having a significantly higher rate of fusion, better clinical outcome and a similar rate of general and treatment-related complications. 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