C2 odontoid peg fractures in patients aged 75 and above: single centre experience of 112 patients managed non-surgically

Although a small cohort of 11 patients were treated without a hard collar (10 of whom used soft collars), the outcomes in terms of union rates were comparable to those of patients managed with hard collars. This suggests that soft collar immobilisation may represent a viable alternative in terms of both radiological and clinical bone healing, as well as fibrous healing, compared to the traditional treatment option of hard collar immobilisation. With the high mortality associated with these injuries, C2 odontoid peg fractures in elderly patients require a personalised treatment approach, considering age, fracture type, and patient compliance. We also advise a broader scope of practice in terms of recognising falls as a risk factor for odontoid peg fractures in elderly patients and emphasise the need for improved fall management and addressing frailty to reduce the risk of these injuries.