Are hard collars necessary for older people with odontoid neck fractures?

Neck (cervical) fractures can occur when older or frail people sustain a low impact fall. These fractures are increasing in incidence as the population ages. The second cervical vertebra, whose bony protuberance is known as the odontoid peg, or dens, is most affected1 (fig 1). More than 85% of odontoid fractures occur in people over 65.2 In standard care in the UK and elsewhere, most patients with suspected cervical spine injuries are immobilised with non-padded trauma collars or blocks, possibly on spinal boards, on admission to the emergency department. A hard collar is usually applied once a cervical fracture is diagnosed.

Surgical treatment is high risk for complications in older and frail patients,3 so all cervical fracture types in these patients are commonly managed with six to 12 weeks’ immobilisation in a hard collar. Compared with not wearing a collar, hard collars increase the chance of bony healing at the fracture site.3 Bony healing does not affect patient outcomes, however, because an effective non-bony fibrous union usually occurs that stabilises the fracture, even without wearing a collar.45 It may therefore not be necessary to wear a collar at all. Furthermore, hard …