In:
ANZ Journal of Surgery, Wiley, Vol. 84, No. 5 ( 2014-05), p. 320-325
Abstract:
Non‐surgical immobilization strategies for type 2 odontoid fractures vary considerably, with some surgeons preferring rigid collars, halothoracic bracing or the M inerva brace. Choice of device should be informed by the effectiveness in achieving union, whilst minimizing mortality and complications. Objectives Perform a systematic review evaluating the efficacy of non‐surgical interventions for type 2 odontoid fractures. Data Sources MEDLINE ( OvidSP ), EMBASE ( OvidSP ) and T he C ochrane L ibrary, C linical T rials.gov, C urrent C ontrolled T rials. Methods We conducted a systematic review of studies directly comparing the halothoracic brace and cervical collars or the M inerva brace for union, mortality and complications. Studies were appraised for quality and bias, and results were pooled for analysis. Results 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 ( RR ) 1.27 (95% confidence intervals ( CI ) 1.03 to 1.57; P = 0.03); and airway complications; RR 7.52 (95% CI 1.39 to 40.83; P = 0.02) with halothoracic bracing compared with cervical collar. In patients 〉 65, there was a greater risk of airway complications; RR 7.50 (0.96–58.36; P = 0.05). No other significant differences were identified. Conclusion Evidence to support selection of non‐surgical immobilization in type 2 odontoid fractures is poor. Osseous union has traditionally been the benchmark for ‘successful’ treatment; however, evidence of association between union and improved outcomes is lacking. We highlight the need for a randomized study to promote evidence‐based decision‐making in the non‐surgical management of this injury.
Type of Medium:
Online Resource
ISSN:
1445-1433
,
1445-2197
DOI:
10.1111/ans.2014.84.issue-5
Language:
English
Publisher:
Wiley
Publication Date:
2014
detail.hit.zdb_id:
2095927-8
