title: Minimally invasive technique of triple anterior screw fixation for an acute combination atlas-axis fracture: case report and literature review.
abstract: METHODS
  A case report to describe the minimally invasive technique of treating C1-type II odontoid combination fractures.
  
  
  OBJECTIVE
  To introduce a new, minimally invasive technique of triple anterior screw fixation for acute combination atlas-axis fractures.
  
  
  BACKGROUND
  Management for C1-type II odontoid combination fractures includes traction, immobilization and posterior fusion with and without instrumentation and anterior odontoid screw fixation. The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures.
  
  
  METHODS
  A case of combination atlas-type II odontoid fracture occurred in a 39-year-old man. Imaging examinations showed a fracture of the unilateral anterior and posterior arch of C1 associated with type II odontoid fracture and with significant prevertebral soft tissue edema. Treatment consisted of odontoid and bilateral C1-C2 transarticular screw fixation through bilateral anterior small incisions.
  
  
  RESULTS
  The patient was mobilized early postoperatively with a hard cervical collar and discharged 4 days later. On 2-year follow-up, he presented no cervical complaints and only mild reduction in neck rotation.
  
  
  CONCLUSIONS
  In case of C1-type II odontoid fracture, the triple anterior screw fixation can be taken into consideration as an alternative because of its superiority of minimal invasion, stability and safety.
authors.affiliation: Department of Orthopedics, The Provincial People's Hospital of Shanxi, Taiyuan, Shanxi 30012, China. qindean.student@sina.com
authors.forename: Q
authors.initials: Q
authors.lastname: Dean
authors.forename: S
authors.initials: S
authors.lastname: Jiefu
authors.forename: W
authors.initials: W
authors.lastname: Jie
authors.forename: S
authors.initials: S
authors.lastname: Yunxing
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries*; D001863:Bone Screws; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome