Atrophic mandible fractures represent a clinical challenge due to both the peculiarities of the population involved and the management of a limited bone remnant. The choice of the type of osteosynthesis is guided by some criteria, including the degree of fracture comminution and the height of the bone remnant, where residual mandibular bone height <10 mm represents an important clinical challenge and is related to major postoperative complications. The aim of this study is to report the efficacy of the load-bearing osteosynthesis in a bilateral atrophic mandible fracture. An 86-year-old male patient, victim of a fall from his own height, evolving with a bilateral body fracture in the atrophic lower jaw. This fracture occurred adjacent to the endof a reconstruction locking plate installed 18 months ago to treat a fracture in the mandibular parasymphysis, requiring a surgical approach to removal the previous fixation and installation of two locking reconstruction plates in each fractured segment. Inthe six months of follow-up, no complication was observed. The uniqueness of this case reinforces the therapy with load-bearing plates and its clinical efficiency.