Posterior Fixation Combined with Anterior Transoral Plate Osteosynthesis for Chronic Gehweiler IIIb Atlas Fracture-Dislocation: Case Report and Literature Review.

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-dislocation, thereby providing a reference for similar cases. Methods: A patient with atlas fracture-dislocation 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-plate 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's 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-dislocation. This surgical strategy demonstrates favorable therapeutic outcomes for refractory atlas fractures and warrants clinical application in analogous scenarios, but still requires extensive clinical verification.