Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 1, pp 43–51 | Cite as

Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases

  • Yann Philippe CharlesEmail author
  • Yves Ntilikina
  • Benjamin Blondel
  • Stéphane Fuentes
  • Jérémy Allia
  • Nicolas Bronsard
  • Maxime Lleu
  • Benjamin Nicot
  • Vincent Challier
  • Joël Godard
  • Pascal Kouyoumdjian
  • Nicolas Lonjon
  • Paulo Marinho
  • Julien Berthiller
  • Eurico Freitas
  • Cédric Barrey
Trauma Surgery



The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment.


Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson–D’Alonzo and Roy–Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation.


Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment.


Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.


Odontoid fracture Epidemiology Morbidity Mortality Fusion 



The authors would like to thank the French Society of Spine Surgery (SFCR) for funding the online database (KEOPS) license and the methodological support provided by the Pôle IMER (Lyon, France).


The French Society of Spine Surgery (SFCR) funded the online database (KEOPS) license and the methodological support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval (Reference FC 2018-28) was obtained for this observational study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yann Philippe Charles
    • 1
    Email author
  • Yves Ntilikina
    • 1
  • Benjamin Blondel
    • 2
  • Stéphane Fuentes
    • 2
  • Jérémy Allia
    • 3
  • Nicolas Bronsard
    • 3
  • Maxime Lleu
    • 4
  • Benjamin Nicot
    • 5
  • Vincent Challier
    • 6
  • Joël Godard
    • 7
  • Pascal Kouyoumdjian
    • 8
  • Nicolas Lonjon
    • 9
  • Paulo Marinho
    • 10
  • Julien Berthiller
    • 11
  • Eurico Freitas
    • 12
  • Cédric Barrey
    • 12
  1. 1.Service de chirurgie du rachisHôpitaux Universitaires de StrasbourgStrasbourg CedexFrance
  2. 2.Unité de chirurgie du rachisUniversité Aix-Marseille, CHU TimoneMarseilleFrance
  3. 3.Unité de Chirurgie RachidienneInstitut Universitaire de l’appareil Locomoteur et du Sport, Hôpital Pasteur 2, CHU de NiceNiceFrance
  4. 4.Service de neurochirurgieCHU de DijonDijon CedexFrance
  5. 5.Département de neurochirurgieCHU de GrenobleLa TroncheFrance
  6. 6.Unité d’orthopédie-traumatologie rachis IHôpital Tripode, CHU de BordeauxBordeaux cedexFrance
  7. 7.Service de neurochirurgieHôpital Jean-MinjozBesançon CedexFrance
  8. 8.Service d’orthopédie-traumatologieCHU de NîmesNîmesFrance
  9. 9.Service de neurochirurgieHôpital Gui de ChauliacMontpellierFrance
  10. 10.Service de neurochirurgieHôpital Roger-Salengro, CHRU de LilleLilleFrance
  11. 11.Pôle IMERHospices Civils de LyonLyon Cedex 03France
  12. 12.Service de neurochirurgie C et chirurgie du rachisHôpital P Wertheimer, Hospices Civils de Lyon, Université Claude Bernard Lyon 1LyonFrance

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