Markgroningen

Researchers are evaluating treatment options for unstable odontoid fractures in adults aged 70 years and older. This study compares surgery and rigid collar bracing to determine which leads to better recovery in daily activities, pain control, disability, and quality of life. It aims to provide clear evidence about which treatment supports improved functional outcomes and healing for older adults with these fractures. Participants are randomly assigned to either surgical stabilization using a posterior C1-C2 screw-rod system or conservative treatment with a rigid cervical collar worn for 12 weeks. Surgery typically lasts about 100 minutes and requires a hospital stay of around 6 days without additional external bracing. The conservative group will record collar use in diaries to monitor compliance. Patients are followed for 12 weeks and 6 months, with an extra visit about 2 weeks after surgery for those who undergo the procedure. Those in the collar group may switch to surgery within 12 weeks if needed. During the study, participants will attend visits at 12 weeks and 6 months to complete questionnaires on daily functioning, pain, and quality of life. CT scans and medical assessments will be performed to monitor fracture healing and complications. Researchers will track treatment adherence, any crossover to surgery, and adverse events. The main outcome measured is change in the Barthel Index from baseline to 12 weeks, which reflects recovery in daily living activities.