Effective Use of Halo-Vest in Treating Type II and III Odontoid Fractures

In a recent cross-sectional retrospective study published in the International Journal of General Medicine, researchers investigated the effectiveness of halo vest immobilization (HVI) in the treatment of type II and III odontoid fractures. The study, conducted at King Saud Medical City Orthopedic Department, examined the radiological and clinical outcomes of patients who had undergone this conservative treatment method.

Odontoid fractures are injuries to the second cervical vertebra, with type II fractures carrying a significant risk of instability due to nonunion. The study included 45 patients with either type II or type III odontoid fractures, treated with halo vest applications. The researchers observed that only 15.6% of the patients with type II fractures achieved union, whereas 28.9% experienced malunion and 11.1% ended up with nonunion. For type III fractures, similar rates of union and malunion were observed, with only 4.4% resulting in nonunion. These findings suggest that HVI treatment requires prolonged cervical immobilization, and various factors can influence the success rate.

Focusing on the treatment protocol, patient adherence, and inherent difficulties associated with HVI, the study acknowledges a considerable rate of reduction loss potentially leading to malunion or nonunion. The study recommended a shift toward surgical intervention for all type II odontoid fractures, as HVI’s efficacy may be limited to non-displaced fractures.

Data analysis revealed that irrespective of the fracture type or patient’s age, the worst prognostic combination was anterior displacement succeeded by posterior angulation. This often resulted in malunion or nonunion, pointing to the need for a careful assessment of the fracture’s biomechanical properties during treatment planning. Misalignment and displacement worsened significantly after HVI, suggesting that displacement exceeding 4mm is associated with undesirable outcomes.

Overall, the study highlighted the need for a change in the treatment protocol for type II odontoid fractures from conservative HVI to surgical treatment, given the associated challenges and complications of nonsurgical methods. The clinical and radiological outcomes of this study’s findings have led to protocol changes in treating odontoid fractures, underscoring the importance of considering surgical options for these cases.

The authors disclosed no conflicts of interest related to the study, which did not receive any specific funding. The study received institutional review board approval, and all subjects provided written informed consent prior to participation. The findings reflect the opinions of the authors and not necessarily those of Dove Medical Press Ltd or its employees.

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