Background: Odontoid fractures are the most common neck bone fractures in elderly patients and form about 10–15% of all cervical spine injuries. There is still no clear agreement on the best treatment — whether to treat with immobilisation (conservative) or surgery, especially in older patients. This study aimed to compare the outcomes of these two treatment methods. Methods: This was a bidirectional comparative study conducted at a tertiary care hospital in Chennai, including 76 patients with confirmed odontoid fractures. Patients who underwent conservative treatment (38 patients, using cervical collar or halo) and surgical treatment (38 patients, treated with anterior screw fixation or posterior C1–C2 fusion) were followed up and compared for Outcomes such as fracture healing, new neurological problems, complications, death, hospital and ICU stay, and functional recovery using Neck Disability Index (NDI) and Visual Analogue Scale (VAS). Statistical tests were applied, and p < 0.05 was considered significant. Results: Fracture healing was much higher in the surgical group (73.3% compared to 26.7%). New neurological problems occurred only in the conservative group. Patients who underwent surgery had longer hospital stay (28.08 ± 9.27 days vs 14.87 ± 4.39 days) and ICU stay (12.95 ± 3.74 days vs 5.18 ± 2.57 days). Complications were more common in the surgical group (75% vs 25%). Death was higher in the conservative group, but this was not statistically significant. Both groups showed improvement in NDI and VAS scores, with slightly better results in the surgical group at one year. Logistic regression did not show any independent factors predicting outcomes. Conclusion: Surgical treatment gives better fracture healing and prevents neurological problems, but it has more complications and requires longer hospital stay. Conservative treatment has fewer complications and shorter hospital stay. Treatment should be decided based on patient condition, fracture type, neurological status, and fitness for surgery.
Sureshkumar et al. (Wed,) studied this question.