To separate dens fractures into SFs and UFs is feasible. There was no significant difference in the 30-day overall case fatality ( P = 0.3786). A primary non-union occurred more often in type II than in type III fractures ( P = 0.0023). Twenty-one type II SFs (91%) consolidated with a nonoperative management ( P < 0.001). UF group ( n = 32): A posterior C1–C2 fusion was carried out in 23 patients, a C0 onto C4 stabilization in 7 and an anterior odontoid screw fixation in 2. SF group ( n = 57): A primary stable union was observed in 35, a stable non-union in 10, and an unstable non-union in 8 patients of which 4 were treated with a C1/2 fixation. The classification into SFs and UFs was significant for its angulation ( P = 0.0006) and displacement ( P < 0.0001). SFs were treated with a semi-rigid immobilization for 6 weeks, UFs surgically-preferably with a C1–C2 posterior fusion. Fractures were categorized as stable or unstable distinguished by the parameters of its angulation ( 11°) and displacement ( 5 mm) with a follow-up time of 6 months. Each patient was categorized with CT scans to evaluate the type of fracture, fracture gap (mm), fracture angulation (°), fracture displacement (mm) and direction (ventral, dorsal). There were 89 patients ≥ 65 years who presented at our institution with type II and III odontoid fractures from 2003 until 2017 and were included in this study. The authors propose that the simple Anderson and D’Alonzo classification may not be sufficient for geriatric patients. Results are based on the literature and on our own experience. We carried out a retrospective cohort study to differentiate geriatric odontoid fractures into stable and unstable and correlated it with fracture fusion rates.
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