PMID- 31365449
OWN - NLM
STAT- MEDLINE
DCOM- 20201016
LR  - 20201016
IS  - 1531-2291 (Electronic)
IS  - 0890-5339 (Linking)
VI  - 33
IP  - 12
DP  - 2019 Dec
TI  - Association Between Frailty Status and Odontoid Fractures After Traumatic Falls: 
      Investigation of Varying Injury Mechanisms Among 70 Elderly Odontoid Fracture 
      Patients.
PG  - e484-e488
LID - 10.1097/BOT.0000000000001597 [doi]
AB  - 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.
FAU - Alas, Haddy
AU  - Alas H
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
FAU - Segreto, Frank A
AU  - Segreto FA
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
FAU - Chan, Hoi Ying
AU  - Chan HY
AD  - Department of Orthopedic Surgery, Waikato Hospital, Hamilton, New Zealand.
FAU - Brown, Avery E
AU  - Brown AE
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
FAU - Pierce, Katherine E
AU  - Pierce KE
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
FAU - Bortz, Cole A
AU  - Bortz CA
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
FAU - Horn, Samantha R
AU  - Horn SR
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
FAU - Varlotta, Christopher G
AU  - Varlotta CG
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
FAU - Baker, Joseph F
AU  - Baker JF
AD  - Department of Orthopedic Surgery, Waikato Hospital, Hamilton, New Zealand.
FAU - Passias, Peter G
AU  - Passias PG
AD  - Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, 
      NYU Langone Medical Center, NY Spine Institute, New York, NY.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Orthop Trauma
JT  - Journal of orthopaedic trauma
JID - 8807705
SB  - IM
MH  - Accidental Falls/*statistics & numerical data
MH  - Accidents, Traffic/statistics & numerical data
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Frailty/*complications/mortality
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Odontoid Process/*injuries
MH  - Outcome Assessment, Health Care
MH  - Retrospective Studies
MH  - Spinal Fractures/diagnosis/*epidemiology/therapy
MH  - Survival Rate
EDAT- 2019/08/01 06:00
MHDA- 2020/10/21 06:00
CRDT- 2019/08/01 06:00
PHST- 2019/08/01 06:00 [pubmed]
PHST- 2020/10/21 06:00 [medline]
PHST- 2019/08/01 06:00 [entrez]
AID - 10.1097/BOT.0000000000001597 [doi]
PST - ppublish
SO  - J Orthop Trauma. 2019 Dec;33(12):e484-e488. doi: 10.1097/BOT.0000000000001597.