Dens fractures in the elderly. Results of anterior screw fixation in 19 elderly patients.

Type 2 dens fractures in the elderly may be regarded as fragility fractures due to osteoporosis and are prone to nonunion with closed treatment. We investigated the outcome of direct anterior screw fixation of these fractures in 19 patients over 65 years of age. The type of injury, radiological appearance over time and the clinical outcome were analyzed, with an average follow-up of 4.5 years. Surgery and postoperative treatment were tolerated well in all patients. In 16 cases, bony union was achieved after 3-6 months. 2 pseudarthroses, which required no treatment, occurred. At follow-up, 15 patients had no symptoms. 10 of the patients had diminished rotation. We conclude that anterior screw fixation is a successful therapy in most cases of type 2 dens fractures in the elderly.