PEG and other cervical‑spine (C‑spine) fractures in the elderly
Cervical‑spine fractures in older people commonly result from low‑energy mechanisms (standing or sitting falls) because of age‑related bone fragility (osteoporosis), degenerative change and reduced soft‑tissue resilience.
Odontoid (peg, C2) fractures are particularly frequent and have management implications different from those in younger adults.
In the emergency department (ED) maintain a low threshold for imaging, avoid premature removal of immobilisation, document neurological status and involve spinal/neurosurgical specialists early (NICE NG41; NG232).
Why this matters in frailty and the ED
- Low‑mechanism falls in older adults can cause clinically significant C‑spine injury; age ≥65 years is itself a high‑risk feature that usually mandates imaging (NICE NG41/NG232).
- Odontoid (peg) fractures-especially Anderson & D'Alonzo Type II-have high non‑union rates and management must balance fracture stability against frailty and operative risk.
- Prolonged or unnecessary immobilisation is harmful (pressure damage, dysphagia, delirium); minimise collar duration once clinical and imaging clearance is possible (NICE NG41).
- Follow systematic pathways: clinical decision rule → timely CT → MRI if cord or ligament injury suspected → early specialist contact for unstable injuries (NICE NG41; NG232).
Initial approach in the ED
Immediate priorities
- Follow ATLS (Advanced Trauma Life Support): airway (with C‑spine protection), breathing, circulation. If the airway must be secured, prioritise it while maintaining manual in‑line stabilisation.