Alhamal HA, Alhaddad S, Alsaleh B, Güneş L, Alzawad A, Azzam L, Alhabib M, Alhalal I, Alhamal H. Motion preserving fixation of an unstable Jefferson fracture using C1 lateral mass screws and rods: A case report. World J Orthop 2026; 17(5): 119240 [DOI: 10.5312/wjo.v17.i5.119240]
Corresponding Author of This Article
Hadi Alaa Alhamal, College of Medicine, Imam Abdulrahman Bin Faisal University, King Faisal Road, Al Rakah, As Safa, Dammam 34212, Saudi Arabia. hadialhamal@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Alhamal HA, Alhaddad S, Alsaleh B, Güneş L, Alzawad A, Azzam L, Alhabib M, Alhalal I, Alhamal H. Motion preserving fixation of an unstable Jefferson fracture using C1 lateral mass screws and rods: A case report. World J Orthop 2026; 17(5): 119240 [DOI: 10.5312/wjo.v17.i5.119240]
World J Orthop. May 18, 2026; 17(5): 119240 Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.119240
Motion preserving fixation of an unstable Jefferson fracture using C1 lateral mass screws and rods: A case report
Hadi Alaa Alhamal, Sarah Alhaddad, Bayan Alsaleh, Lina Güneş, Abdulaziz Alzawad, Leen Azzam, Mohammed Alhabib, Ibrahim Alhalal, Hussain Alhamal
Hadi Alaa Alhamal, Sarah Alhaddad, Abdulaziz Alzawad, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
Bayan Alsaleh, College of Medicine, Sechenov Medical University, Moscow 119435, Russia
Lina Güneş, Department of Medicine and Surgery, Fakeeh College for Medical Science, Jeddah 23323, Saudi Arabia
Leen Azzam, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 228, Bahrain
Mohammed Alhabib, Ibrahim Alhalal, Hussain Alhamal, Department of Neurosurgery, Qatif Central Hospital, Qatif 32654, Saudi Arabia
Author contributions: Alhamal H, Alhalal I, and Alhabib M involved in patient care; Alhamal HA, Alhamal H, and Alhabib M, Alhaddad S, Alsaleh B, Güneş L, Alzawad A, Azzam L contributed to data collection and interpretation, manuscript drafting and revision, and approved the final version of the manuscript; and all authors contributed to this paper.
AI contribution statement: During the preparation of this work the authors used ChatGPT, OpenAI-version 5.1 in order to solely enhance the grammar, clarity, and readability of the manuscript. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article. Additionally, no images in the manuscript were generated by artificial intelligence.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hadi Alaa Alhamal, College of Medicine, Imam Abdulrahman Bin Faisal University, King Faisal Road, Al Rakah, As Safa, Dammam 34212, Saudi Arabia. hadialhamal@gmail.com
Received: February 26, 2026 Revised: February 16, 2026 Accepted: March 18, 2026 Published online: May 18, 2026 Processing time: 116 Days and 14.4 Hours
Abstract
BACKGROUND
Jefferson fractures of the atlas (C1) are burst-type injuries commonly caused by axial loading. Fracture stability depends largely on the integrity of the transverse atlantal ligament (TAL). While stable injuries may be treated conservatively, unstable fractures often require surgical stabilization. Fusion-based techniques provide reliable stability but significantly restrict upper cervical motion. This report describes a motion-preserving posterior fixation technique for an unstable Jefferson fracture.
CASE SUMMARY
A 32-year-old man sustained an unstable C1 Jefferson fracture (Gehweiler type IIIB) following a fall from a height. Imaging demonstrated fractures of the anterior and posterior arches with associated TAL disruption. After initial cervical immobilization, the patient underwent direct posterior C1 fixation with bilateral lateral mass screws and rod constructs. Intraoperatively, the vertebral artery was found to be entrapped between posterior arch fragments, requiring careful blunt dissection. The procedure was completed without complications. Postoperative imaging confirmed satisfactory reduction and stable fixation. At 1 year and 9 months of follow-up, computed tomography demonstrated bony union, and dynamic radiographs confirmed atlantoaxial stability. Clinical assessment revealed full, pain-free cervical range of motion.
CONCLUSION
Direct C1 lateral mass screw–rod fixation provided effective stabilization of an unstable Jefferson fracture while preserving upper cervical mobility.
Core Tip: Unstable Jefferson fractures are traditionally managed with fusion-based techniques that sacrifice atlantoaxial motion. This case report highlights a motion-preserving surgical approach using C1 (atlas) fixation with lateral mass screws and rods, achieving fracture union while maintaining cervical mobility. To our knowledge, this represents the first reported case in Saudi Arabia managed with this technique, providing regional evidence supporting motion-preserving strategies for selected unstable atlas fractures.
