title: Management of acute combination atlas-axis fractures with percutaneous triple anterior screw fixation in elderly patients.
abstract: BACKGROUND
  Patients 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.
  
  
  METHODS
  Seven 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Using 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.
  
  
  METHODS
  Level IV. Retrospective study.
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, #109 XueYuan Western Road, WenZhou, ZheJiang, China. aiminwu@163.com
authors.forename: A M
authors.initials: AM
authors.lastname: Wu
authors.forename: X Y
authors.initials: XY
authors.lastname: Wang
authors.forename: Y L
authors.initials: YL
authors.lastname: Chi
authors.forename: H Z
authors.initials: HZ
authors.lastname: Xu
authors.forename: W
authors.initials: W
authors.lastname: Weng
authors.forename: Q S
authors.initials: QS
authors.lastname: Huang
authors.forename: W F
authors.initials: WF
authors.lastname: Ni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001368:Axis, Cervical Vertebra / Q000293:injuries* / Q000601:surgery*; D001863:Bone Screws; D001270:Cervical Atlas / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*