{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:43:03Z","timestamp":1787755383572,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Case Connector"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 47-year-old woman presented with an unstable C1 fracture after falling down several stairs. She was found to have a sagittal split fracture of the right C1 lateral mass extending into the posterior arch. The fracture was treated with a direct posterior osteosynthesis of C1 using lateral mass screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Surgical management of unstable C1 fractures has traditionally involved posterior fusion of C1 to C2 or fusion from the occiput to C2. These fusion procedures can be quite functionally limiting. Recently, direct osteosynthesis of C1 has been shown to be an effective, motion-preserving alternative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.17.00119","type":"journal-article","created":{"date-parts":[[2018,2,14]],"date-time":"2018-02-14T12:16:17Z","timestamp":1518610577000},"page":"e9-e9","source":"Crossref","is-referenced-by-count":2,"title":["Unstable C1 Fracture Managed with Internal Fixation Using Lateral Mass Screws"],"prefix":"10.2106","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7666-0529","authenticated-orcid":false,"given":"Jonathan C.","family":"Yu","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Niemeier","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakthivel R.","family":"Manoharan","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2,14]]},"reference":[{"issue":"27","key":"bib1-20230713","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1002\/bjs.1800072713","article-title":"Fracture of the atlas vertebra. 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Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures","volume":"29","author":"Dickman","year":"2004","journal-title":"Spine"},{"issue":"7","key":"bib10-20230713","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1097\/01.BRS.0000116984.42466.7E","article-title":"Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures","volume":"29","author":"Ruf","year":"2004","journal-title":"Spine (Phila Pa 1976)."},{"issue":"10","key":"bib11-20230713","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1007\/s00701-012-1471-5","article-title":"Fully endoscopic endonasal anterior C1 arch reconstruction as a function preserving surgical option for unstable atlas fractures","volume":"154","author":"Iacoangeli","year":"2012","journal-title":"Acta Neurochir (Wien)."},{"issue":"10","key":"bib12-20230713","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1007\/s00586-013-2870-x","article-title":"Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach","volume":"22","author":"Ma","year":"2013","journal-title":"Eur Spine J."},{"issue":"22","key":"bib13-20230713","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1097\/00007632-200111150-00014","article-title":"Posterior C1-C2 fusion with polyaxial screw and rod fixation","volume":"26","author":"Harms","year":"2001","journal-title":"Spine (Phila Pa 1976)."},{"issue":"15","key":"bib14-20230713","doi-asserted-by":"crossref","first-page":"E1046","DOI":"10.1097\/BRS.0b013e3181fef78c","article-title":"Direct posterior C1 lateral mass screws compression reduction and osteosynthesis in the treatment of unstable Jefferson fractures","volume":"36","author":"Li","year":"2011","journal-title":"Spine (Phila Pa 1976)."},{"issue":"6","key":"bib15-20230713","doi-asserted-by":"crossref","first-page":"E219","DOI":"10.1097\/BSD.0b013e31829a36c5","article-title":"Function-preserving reduction and fixation of unstable Jefferson fractures using a C1 posterior limited construct","volume":"27","author":"Hu","year":"2014","journal-title":"J Spinal Disord Tech."},{"issue":"5","key":"bib16-20230713","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.jocn.2010.08.033","article-title":"Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct","volume":"18","author":"Jo","year":"2011","journal-title":"J Clin Neurosci."},{"issue":"9","key":"bib17-20230713","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1007\/s00113-006-1081-x","article-title":"[Direct osteosynthesis of instable Gehweiler Type III atlas fractures. 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