Background: A dens fracture is the most common cervical fracture in
elderly patients. The purposes of this study were to analyze the functional
and radiographic results after surgical treatment of dens fractures in
patients over sixty-five years of age and to compare the two methods that were
used for operative treatment.
Methods: We reviewed the cases of fifty-six patients, with an
average age of 71.4 years at the time of surgery, who had undergone surgical
treatment of a dens fracture from 1988 to 2002. Thirty-seven fractures were
stabilized with anterior screw fixation, and nineteen fractures had posterior
Results: Forty-five patients returned to their preinjury activity
level and were satisfied with their treatment. Thirty-five patients had a full
range of neck movement, and forty-seven patients were free of pain. Technical
failures occurred in eight patients. The thirty-seven patients treated with
anterior screw fixation had a good clinical outcome, with fracture-healing in
thirty-three patients (89%) and technical failure in five patients (14%). All
nineteen patients treated with posterior cervical arthrodesis had fracture
union, with technical failure in three patients, but the functional results
were worse than those after anterior screw fixation. With the inclusion of the
six patients who had been excluded from the clinical and radiographic review,
the overall morbidity rate was 16% (ten of sixty-two patients) and the overall
mortality rate was 6% (four of sixty-two patients).
Conclusions: A satisfactory outcome can be achieved with surgical
treatment of a dens fracture in geriatric patients. It appears that anterior
screw fixation may maintain better mobility of the cervical spine, but it
appears to be associated with a higher rate of fracture nonunion and a greater
potential for reoperation.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.