BACKGROUND: The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures. When feasible, it ensures early maximal stability, even if it slightly reduces the mobility of C1-C2 complex. We report a case of combination atlas-type II odontoid fracture that occurred in a 92-year-old man. The instability was treated with odontoid screw fixation and anterior bilateral C1-C2 transarticular screw fixation in a single stage. The aim of the article is to describe the feasibility of "triple" anterior screw fixation in the presence of C1-type II odontoid fracture. METHODS: The diagnosis, treatment, and outcome of a 92-year-old patient with mild tetraparesis caused by C1-type II odontoid fracture were assessed. RESULTS: Cervical x-rays, computed tomographic scan, and magnetic resonance imaging demonstrated a fracture of posterior arch of C1, associated with type II odontoid fracture and with presumable damage of C1 transverse ligament. Magnetic resonance imaging also showed a high cervical centromedullary area slightly hyperintense in T1-weighted images. Treatment consisted of odontoid and bilateral C1-C2 transarticular screw fixation with single anterior approach. The admission neurologic conditions improved and the patient was early mobilized. CONCLUSIONS: The authors suggest that in presence of C1-type II odontoid fracture, the triple anterior screw fixation has to be taken into account as salvage procedure, especially if other methods of stabilization failed or cannot be safely performed. This technique seems to be safety feasible also in old patients, as our report and the experience of others confirm.