Management of acute combination atlas–axis fractures with percutaneous triple anterior screw fixation in elderly patients

SummaryIntroductionPatients with combined C1-2 fractures were often treated by posterior arthrodesis. However, elderly patients with multiple injuries (such as brain injury), the large surgical trauma of posterior arthrodesis will increase the risk of perioperative mortality. A minimally invasive technique may be better for them, and decrease the risk of perioperative mortality.Materials and methodsSeven patients with combined C1-2 fractures underwent percutaneous anterior odontoid screw and anterior C1-2 transarticular screws (percutaneous triple anterior screws fixation). The surgical technique of percutaneous triple anterior screws fixation is described.ResultsThe operation performed on all patients successfully without technical difficulties, and no intra-operative surgery-related complications such as vertebral artery, nerve injury and soft tissue complications occurred. No pullout, loosening, or breakage of internal screws was observed. C1/2 stable was found in all cases and radiographic union achieved in all odontoid fractures.ConclusionUsing the appropriate instruments allied to intra-operative image-intensification, we suggest that percutaneous triple anterior screw fixation is reliable, effective and minimally invasive procedure for elderly and brain injured patients suffering of combined atlas–axis fractures.Level of evidenceLevel IV. Retrospective study.