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.