• Emma Shears and Christopher P Armitstead.
• Spinal Unit, Royal Orthopaedic Hospital, Bristol Road, Northfield, Birmingham, West Midlands, UK, B31 2AP. shears@doctors.org.uk
• Cochrane Db Syst Rev. 2008 Oct 8 (4): CD005078.

BackgroundFractures of the odontoid process of the second cervical vertebra can result in instability, neurological damage and death. Treatment includes conservative management (external immobilisation devices) or surgical treatment (internal fixation by posterior fusion or anterior screw fixation).ObjectivesTo compare surgical with conservative treatment for fractures of the odontoid process.Search StrategyWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to February 2008), EMBASE (1988 to February 2008), LILACS (accessed February 2008), reference lists of articles and registries of ongoing trials.Selection CriteriaRandomised and quasi-randomised controlled trials comparing surgical versus conservative management of odontoid fractures.Data Collection And AnalysisTwo review authors independently examined the search results to identify trials for inclusion.Main ResultsWe did not identify any studies that met our inclusion criteria. We excluded one ongoing and registered study that is comparing surgery versus conservative treatment because it does not involve randomisation of treatment allocation.Authors' ConclusionsThere is no evidence available from adequately controlled trials to inform the decision on whether the surgical treatment of odontoid fractures gives a better outcome. A sufficiently powered good quality multicentre randomised controlled trial comparing surgery versus conservative treatment is warranted.

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