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Clin Neurol Neurosurg. 2013 Oct;115(10):2056-61. doi: 10.1016/j.clineuro.2013.07.006. Epub 2013 Jul 31.

Elderly patients are at increased risk for mortality undergoing surgical repair of dens fractures.

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Department of Neurosurgery, Universitätsklinikum Essen, Essen, Germany. Electronic address:



Dens fractures are common cervical injuries in advanced aged patients. The presented study was undertaken to analyze the clinical results and risks of surgically treated patients with dens fractures over 70 years.


Data of 28 patients (17 female, 11 male) over 70 years treated from September 2004 to October 2009 were recorded. Clinical and radiological parameters were obtained including type of fracture, associated cervical and/or other injuries, comorbidities, symptoms, neurological condition, surgical strategy, postoperative course and complications.


89% were in a good neurological condition before surgery (ASIA E or D). In most cases, surgery was performed at an early stage after trauma (21 patients within 5 days). Ventral screw fixation was the preferred surgical strategy (64%). A slight worsening of neurological functions immediately after operation was only seen in one patient. Five patients died in the early and 2 in the late postoperative course which means a treatment mortality of 25%. Among the surviving patients two had general medical complications.


Type II dens fractures are a common fracture of elderly patients. Our results are good concerning the neurological functions. Surgical and general medical complications were acceptable. However, the study also underlines that mortality rate is high and therefore treatment options should be well-considered in this high risk group.


Cervical fracture; Dens fractures; Elderly patients; Odontoid fracture; Ventral screw fixation

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