Association Between Frailty Status and Odontoid Fractures After Traumatic Falls: Investigation of Varying Injury Mechanisms Among 70 Elderly Odontoid Fracture Patients

J Orthop Trauma. 2019 Dec;33(12):e484-e488. doi: 10.1097/BOT.0000000000001597.


Objectives: To determine significant associations between patient frailty status and odontoid fractures across common traumatic mechanisms of injuries (MOIs) in the elderly.

Design: Retrospective review.

Setting: Single, academic-affiliated hospital with full surgical services.

Patients/participants: Patients 65 years or older with traumatic odontoid fractures were included.

Intervention: Nonoperative management (soft/hard collar, halo, traction tongs, and Minerva) and/or operative fixation.

Main outcome measurements: Modified frailty index (mFI), MOI, concurrent injuries, inpatient length of stay (LOS), reoperation, and mortality rates.

Results: Seventy patients were included (80.6 ± 8.5 years, 60% F, 88% European, 10% Maori/Pacific, 1.4% Asian, Charlson Comorbidity Index 5.3 ± 2.2, mFI 0.21 ± 0.15). The most common MOIs were falls (74.3%), high-speed motor vehicle accidents (MVAs) (17.1%), low-speed MVAs (5.7%), and pedestrian versus car (2.9%). Patients with traumatic falls exhibited significantly higher mFI scores (0.25) compared with low-speed MVAs (0.16), high-speed MVAs (0.08), and pedestrian versus car (0.01) (P = 0.003). Twenty-seven patients with odontoid fractures were frail, 33 were prefrail, and 10 were robust. Ninety-two percent of frail patients had a traumatic fall as their MOI, as opposed to 73% of prefrail and 30% of robust patients (P < 0.001). Prefrail and frail patients were 4.3 times more likely than robust patients to present with odontoid fractures through traumatic fall [odds ratio (OR): 4.33 (1.47-12.75), P = 0.008], and frailty increased likelihood of reoperation [OR: 4.2 (1.2-14.75), P = 0.025] and extended LOS [OR: 5.71 (1.05-10.37), P = 0.017]. Frail patients had the highest 30-day (P = 0.017) and 1-year mortality (P < 0.001) compared with other groups.

Conclusion: Patients with traumatic odontoid fractures from falls were significantly more frail in comparison with any other MOIs, with worse short- and long-term outcomes.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Accidental Falls / statistics & numerical data*
  • Accidents, Traffic / statistics & numerical data
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Female
  • Frailty / complications*
  • Frailty / mortality
  • Humans
  • Length of Stay
  • Male
  • Odontoid Process / injuries*
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Spinal Fractures / diagnosis
  • Spinal Fractures / epidemiology*
  • Spinal Fractures / therapy
  • Survival Rate