Non-surgical interventions for the management of type 2 dens fractures: a systematic review

Research output: Contribution to journalArticleResearchpeer-review

11 Citations (Scopus)

Abstract

Background: Non-surgical immobilization strategies for type 2 odontoid fractures vary considerably, with some surgeons preferring rigid collars, halothoracic bracing or the Minerva 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 The Cochrane Library, ClinicalTrials.gov, Current Controlled Trials. Methods: We conducted a systematic review of studies directly comparing the halothoracic brace and cervical collars or the Minerva 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. ? 2013 Royal Australasian College of Surgeons.
Original languageEnglish
Pages (from-to)320 - 325
Number of pages6
JournalANZ Journal of Surgery
Volume84
Issue number5
DOIs
Publication statusPublished - 2014

Cite this

@article{b28cd2225976472cbe3fcd3e63c4d73e,
title = "Non-surgical interventions for the management of type 2 dens fractures: a systematic review",
abstract = "Background: Non-surgical immobilization strategies for type 2 odontoid fractures vary considerably, with some surgeons preferring rigid collars, halothoracic bracing or the Minerva 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 The Cochrane Library, ClinicalTrials.gov, Current Controlled Trials. Methods: We conducted a systematic review of studies directly comparing the halothoracic brace and cervical collars or the Minerva 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. ? 2013 Royal Australasian College of Surgeons.",
author = "David Sime and Pitt, {Veronica Jean} and Loyal Pattuwage and Tee, {Jin W} and Liew, {Susan M} and Gruen, {Russell Lindsay}",
year = "2014",
doi = "10.1111/ans.12401",
language = "English",
volume = "84",
pages = "320 -- 325",
journal = "ANZ Journal of Surgery",
issn = "1445-1433",
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Non-surgical interventions for the management of type 2 dens fractures: a systematic review. / Sime, David; Pitt, Veronica Jean; Pattuwage, Loyal; Tee, Jin W; Liew, Susan M; Gruen, Russell Lindsay.

In: ANZ Journal of Surgery, Vol. 84, No. 5, 2014, p. 320 - 325.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Non-surgical interventions for the management of type 2 dens fractures: a systematic review

AU - Sime, David

AU - Pitt, Veronica Jean

AU - Pattuwage, Loyal

AU - Tee, Jin W

AU - Liew, Susan M

AU - Gruen, Russell Lindsay

PY - 2014

Y1 - 2014

N2 - Background: Non-surgical immobilization strategies for type 2 odontoid fractures vary considerably, with some surgeons preferring rigid collars, halothoracic bracing or the Minerva 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 The Cochrane Library, ClinicalTrials.gov, Current Controlled Trials. Methods: We conducted a systematic review of studies directly comparing the halothoracic brace and cervical collars or the Minerva 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. ? 2013 Royal Australasian College of Surgeons.

AB - Background: Non-surgical immobilization strategies for type 2 odontoid fractures vary considerably, with some surgeons preferring rigid collars, halothoracic bracing or the Minerva 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 The Cochrane Library, ClinicalTrials.gov, Current Controlled Trials. Methods: We conducted a systematic review of studies directly comparing the halothoracic brace and cervical collars or the Minerva 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. ? 2013 Royal Australasian College of Surgeons.

UR - http://onlinelibrary.wiley.com/doi/10.1111/ans.12401/pdf

U2 - 10.1111/ans.12401

DO - 10.1111/ans.12401

M3 - Article

VL - 84

SP - 320

EP - 325

JO - ANZ Journal of Surgery

JF - ANZ Journal of Surgery

SN - 1445-1433

IS - 5

ER -