Survival analysis of elderly patients with a fracture of the odontoid peg
2014
Fractures of the odontoid peg are common spinal
injuries in the elderly. This study compares the survivorship of
a cohort of elderly patients with an isolated fracture of the odontoid
peg versus that of patients who have sustained
a fracture of the hip or wrist. A six-year retrospective analysis
was performed on all patients aged > 65 years who were admitted
to our spinal unit with an isolated fracture of the odontoid peg.
A Kaplan–Meier table was used to analyse survivorship from the date
of fracture, which was compared with the survivorship of similar
age-matched cohorts of 702 consecutive patients with a fracture
of the hip and 221 consecutive patients with a fracture of the wrist. A total of 32 patients with an isolated odontoid fracture were
identified. The rate of mortality was 37.5% (n = 12) at one year.
The period of greatest mortality was within the first 12 weeks.
Time made a lesser contribution from then to one year, and there
was no impact of time on the rate of mortality thereafter. The rate
of mortality at one year was 41.2% for male patients (7 of 17) compared
with 33.3% for females (5 of 15). The rate of mortality at one year was 32% (225 of 702) for patients
with a fracture of the hip and 4% (9 of 221) for those with a fracture
of the wrist. There was no statistically significant difference
in the rate of mortality following a hip fracture and an odontoid
peg fracture (p = 0.95). However, the survivorship of the wrist
fracture group was much better than that of the odontoid peg fracture
group (p < 0.001). Thus, a fracture of the odontoid peg in the
elderly is not a benign injury and is associated with a high rate
of mortality, especially in the first three months after the injury. Cite this article: Bone Joint J 2014;96-B:88–93.
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