Unstable fractures are becoming more common in ill or elderly people. These high-risk surgical patients provide a challenge for surgeons and anesthesiologists. The risk is much higher in patients with an American Society of Anesthesiologists (ASA) score of 3 to 4 due to the high rate of intraoperative complications.

All patients with ASA ratings of 3 to 4 who reported to a level-one trauma hospital with unstable spine fractures received awake spinal percutaneous fixation with moderate sedation and local anesthetic. Demographics, radiology, and outcome data were gathered.

Between 2019 and 2021, 19 patients were operated on. The average duration of follow-up was 12 months (range: 8 to 24 months); 6 patients were female, and thirteen were male. The average age was 77.7 years, and all patients had an ASA score of 3 to 4. About 10 extension-type injuries, six unstable burst injuries, two chance fractures, and one teardrop fracture were reported. All patients had unilateral fixation, and only one had bilateral fixation; 16 of the patients had cement augmentation. There were no neurologic complications detected. One incidence of infection was discovered four months after surgery. All patients were ambulatory when they were released.

Awake fixation is safe and achievable in severe circumstances; a specialized team, including an anesthesiologist and radiologist, is required to address these cases securely and efficiently.

Reference: journals.lww.com/jaaos/Abstract/2022/08010/Awake_Percutaneous_Fixation_for_Unstable_Fractures.10.aspx