{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:39:36Z","timestamp":1785400776412,"version":"3.56.0"},"reference-count":33,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tianjin Health Science and Technology Foundation","award":["TJWJ2025QN049"],"award-info":[{"award-number":["TJWJ2025QN049"]}]},{"award":["TJWJ2025QN049"],"award-info":[{"award-number":["TJWJ2025QN049"]}],"id":[{"id":"https:\/\/ror.org\/02atd1296","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Tianjin Key Medical Discipline Construction Project","award":["TJYXZDXK-3-005A-4"],"award-info":[{"award-number":["TJYXZDXK-3-005A-4"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: This study aims to report a clinical case involving posterior fixation combined with anterior transoral plate osteosynthesis in the management of chronic Gehweiler IIIb atlas fracture\u2013dislocation, thereby providing a reference for similar cases. Methods: A patient with atlas fracture\u2013dislocation following a fall injury underwent surgical intervention. Preoperative diagnosis confirmed Gehweiler IIIb fracture with right atlantoaxial lateral mass dislocation. The treatment protocol involved posterior reduction, instrumentation, and anterior transoral screw\u2013plate fixation. Results: The postoperative recovery was uneventful, with significant alleviation of cervical pain. The most recent follow-up assessment revealed favorable osseous union and appropriate stabilization of the internal implants. The VAS score decreased from 4 preoperatively to 0 postoperatively, and the NDI decreased from 64% to 16%, concurrent with a notable enhancement in the patient\u2019s quality of life. Conclusions: Combined posterior fixation and anterior transoral plate osteosynthesis demonstrates efficacy in ameliorating clinical manifestations and facilitating osseous consolidation in cases of chronic Gehweiler IIIb atlas fracture\u2013dislocation. This surgical strategy demonstrates favorable therapeutic outcomes for refractory atlas fractures and warrants clinical application in analogous scenarios, but still requires extensive clinical verification.<\/jats:p>","DOI":"10.3390\/jcm15145522","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T01:05:58Z","timestamp":1784077558000},"page":"5522","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Posterior Fixation Combined with Anterior Transoral Plate Osteosynthesis for Chronic Gehweiler IIIb Atlas Fracture\u2013Dislocation: Case Report and Literature Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6344-2354","authenticated-orcid":false,"given":"Qingfeng","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, 190 Jieyuan Road, Tianjin 300121, China"},{"name":"Tianjin Institute of Spinal Surgery, Tianjin 300121, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9284-4256","authenticated-orcid":false,"given":"Xiaoming","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, 190 Jieyuan Road, Tianjin 300121, China"},{"name":"Tianjin Institute of Spinal Surgery, Tianjin 300121, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6135-5481","authenticated-orcid":false,"given":"Shibo","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, 190 Jieyuan Road, Tianjin 300121, China"},{"name":"Tianjin Institute of Spinal Surgery, Tianjin 300121, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3958-8398","authenticated-orcid":false,"given":"Wenbin","family":"Xue","sequence":"additional","affiliation":[{"name":"School of Medicine, Nankai University, 94 Weijin Road, Tianjin 300071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7718-4772","authenticated-orcid":false,"given":"Hua","family":"Wei","sequence":"additional","affiliation":[{"name":"The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang 050023, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8184-484X","authenticated-orcid":false,"given":"Junwei","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, 190 Jieyuan Road, Tianjin 300121, China"},{"name":"Tianjin Institute of Spinal Surgery, Tianjin 300121, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3114-0965","authenticated-orcid":false,"given":"Haifeng","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, 190 Jieyuan Road, Tianjin 300121, China"},{"name":"Tianjin Institute of Spinal Surgery, Tianjin 300121, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4919-4434","authenticated-orcid":false,"given":"Yingpeng","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Nankai University, 190 Jieyuan Road, Tianjin 300121, China"},{"name":"Tianjin Institute of Spinal Surgery, Tianjin 300121, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.6061\/clinics\/2013(11)12","article-title":"Fractures of the cervical spine","volume":"68","author":"Marcon","year":"2013","journal-title":"Clinics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1097\/BRS.0b013e31816956de","article-title":"Biomechanical analysis of atlas fractures: A study on 40 human atlas specimens","volume":"33","author":"Gebauer","year":"2008","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"A60","DOI":"10.1227\/01.NEU.0000366108.02499.8F","article-title":"Atlas fractures","volume":"66","author":"Kakarla","year":"2010","journal-title":"Neurosurgery"},{"key":"ref_4","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."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E418","DOI":"10.1097\/BRS.0b013e3181a0ff2f","article-title":"Transoral osteosynthesis C1 as a function-preserving option in the treatment of bipartite atlas deformity: A case report","volume":"34","author":"Hu","year":"2009","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"364","DOI":"10.4103\/jcvjs.JCVJS_94_17","article-title":"Transoral screw and wire fixation for unstable anterior \u00bd atlas fracture","volume":"8","author":"Keskil","year":"2017","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"393","DOI":"10.4103\/jcvjs.jcvjs_112_23","article-title":"Transcervical, retropharyngeal odontoidectomy\u2014Anatomical considerations","volume":"14","author":"Yakdan","year":"2023","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_8","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"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5S","DOI":"10.1177\/2192568217726304","article-title":"Treatment of atlas fractures: Recommendations of the spine section of the german society for orthopaedics and trauma (DGOU)","volume":"8","author":"Kandziora","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"E661","DOI":"10.1097\/BRS.0000000000000874","article-title":"Bipartite atlas or jefferson fracture? A case series and literature review","volume":"40","author":"Allam","year":"2015","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s12178-016-9356-5","article-title":"C1 fractures: A review of diagnoses, management options, and outcomes","volume":"9","author":"Mead","year":"2016","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"411","DOI":"10.3171\/spi.2005.2.4.0411","article-title":"Long-term health-related quality of life outcomes following jefferson-type burst fractures of the atlas","volume":"2","author":"Dvorak","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1007\/s00701-002-0998-2","article-title":"Atlantoaxial screw fixation for the treatment of isolated and combined unstable jefferson fractures\u2014Experiences with 8 patients","volume":"144","author":"Hein","year":"2002","journal-title":"Acta Neurochir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"543","DOI":"10.2106\/00004623-197052030-00013","article-title":"Bursting atlantal fracture associated with rupture of the transverse ligament","volume":"52","author":"Spence","year":"1970","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1097\/00006123-199704000-00061","article-title":"Injuries involving the transverse atlantal ligament: Classification and treatment guidelines based upon experience with 39 injuries","volume":"40","author":"Dickman","year":"1997","journal-title":"Neurosurgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s00264-020-04593-y","article-title":"Injuries of the upper cervical spine\u2014How can instability be identified?","volume":"44","author":"Liao","year":"2020","journal-title":"Int. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1177\/2192568220941452","article-title":"Update on the biomechanics of the craniocervical junction, part II: Alar ligament","volume":"11","author":"Ishak","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3904","DOI":"10.1007\/s00586-024-08460-x","article-title":"Isolated C1 arch fractures: C1-2 fusion vs. C1 osteosynthesis\u2014Surgical strategies for potentially unstable injuries","volume":"33","author":"Denton","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1007\/s00402-008-0706-7","article-title":"Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture","volume":"129","author":"Guo","year":"2009","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.wneu.2023.01.106","article-title":"Robot-assisted percutaneous lag screw osteosynthesis for C1 lateral mass fractures: Case series and technical note","volume":"172","author":"Niu","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"531","DOI":"10.2106\/JBJS.CC.24.00531","article-title":"Floating C1 lateral mass fracture treated with C1-ring osteosynthesis: A case report with a step-by-step surgical guide","volume":"15","author":"Bentz","year":"2025","journal-title":"JBJS Case Connect."},{"key":"ref_22","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."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.spinee.2017.06.029","article-title":"Posterior osteosynthesis with monoaxial lateral mass screw-rod system for unstable C1 burst fractures","volume":"18","author":"Zhang","year":"2018","journal-title":"Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s13018-024-04571-9","article-title":"Direct osteosynthesis in the treatment of atlas burst fractures: A systematic review","volume":"19","author":"Niu","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3171\/2021.12.SPINE211063","article-title":"C1-ring osteosynthesis versus C1\u20132 fixation fusion in the treatment of unstable atlas fractures: A multicenter, prospective, randomized controlled study with 5-year follow-up","volume":"37","author":"Yan","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"50","DOI":"10.4103\/0974-8237.176625","article-title":"Unilateral lag-screw technique for an isolated anterior 1\/4 atlas fracture","volume":"7","author":"Keskil","year":"2016","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Zou, X., Ouyang, B., Wang, B., Yang, H., Ge, S., Chen, Y., Ni, L., Zhang, S., Xia, H., and Wu, Z. (2020). Motion-preserving treatment of unstable atlas fracture: Transoral anterior C1-ring osteosynthesis using a laminoplasty plate. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03575-w"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tu, Q., Chen, H., Li, Z., Chen, Y., Xu, A., Zhu, C., Huang, X., Ma, X., Wang, J., and Zhang, K. (2021). Anterior reduction and C1-ring osteosynthesis with jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04628-4"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zou, X., Yang, H., Deng, C., Fu, S., Chen, J., Ma, R., Ma, X., and Xia, H. (2023). The use of a novel reduction plate in transoral anterior C1-ring osteosynthesis for unstable atlas fractures. Front. Surg., 10.","DOI":"10.3389\/fsurg.2023.1072894"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"101761","DOI":"10.1016\/j.bas.2023.101761","article-title":"Transoral unilateral lag screw osteosynthesis for coronal split fracture of the lateral mass of the atlas\u2014Case report, operative technique and review of the literature","volume":"3","author":"Tinner","year":"2023","journal-title":"Brain Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/BSD.0000000000000631","article-title":"Atlas fractures: Diagnosis, current treatment recommendations, and implications for elderly patients","volume":"31","author":"Smith","year":"2018","journal-title":"Clin. Spine Surg. Spine Publ."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1007\/s00113-010-1896-3","article-title":"Injuries to the upper cervical spine. Part 2: Osseous injuries","volume":"113","author":"Kandziora","year":"2010","journal-title":"Unfallchirurg"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"466","DOI":"10.3171\/2009.1.SPINE08708","article-title":"Unilateral C-1 lateral mass sagittal split fracture: An unstable jefferson fracture variant: Clinical article","volume":"10","author":"Bransford","year":"2009","journal-title":"J. Neurosurg. Spine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5522\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:55:32Z","timestamp":1784174132000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":33,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145522"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145522","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}