Transoral Reduction and Osteosynthesis C1 as a Function-Preserving Option in the Treatment of Unstable Jefferson Fractures
Bibliographic record
Abstract
In Brief Study Design. Retrospective study with clinical and radiologic evaluation of transoral reduction and osteosynthesis of C1 in the treatment of unstable Jefferson fractures. Objective. Assessment of a new method, which preserves the function of the C1–C2 joint in young patients. Summary of Background Data. Unstable Jefferson fractures with rupture of the transverse ligament and high-grade dislocation of the lateral masses of C1 are usually treated conservatively by immobilization or traction or surgical by posterior fusion C1–C2. Methods. Six patients with Jefferson fractures with rupture of the transverse ligament were treated by a transoral approach. Reduction was performed by direct manipulation followed by the osteosynthesis of the anterior ring and the lateral masses of C1. Results. Total average lateral displacement of the lateral masses was 13.5 mm before surgery (range, 8–19 mm) and improved to 4.3 mm after surgery (range 1–8 mm). The total average difference of the atlantal-dens interval in flexion-extension after surgery was 2.0 mm (range 1–3 mm). The average postoperative rotation in the atlantoaxial joint, evaluated by rotation MRI, was in total 39.2° (range 10°–61°). Conclusions. Transoral reduction and osteosynthesis C1 is a new technique that allows maintenance of rotatory mobility in the C1–C2 joint and restoration of congruency in the atlanto-occipital and atlantoaxial joints. None of the patients had symptoms of postoperative instability of C1–C2. Six patients with unstable Jefferson fractures were treated by transoral reduction and osteosynthesis of C1. An anatomical reconstruction of the atlas with bony fusion of the fragments was obtained, preserving rotation of the C1–C2 joint and restoring the congruence of the atlanto-occipital and atlantoaxial joints. There was no major instability.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".