Angle Fractures Research Articles

Prevalence of inferior alveolar nerve injury in patients with mandibular angle fractures presenting to Khyber College of Dentistry, Peshawar: A descriptive study

Prevalence of inferior alveolar nerve injury in patients with mandibular angle fractures presenting to Khyber College of Dentistry, Peshawar: A descriptive study

Evaluation of Polymethylmethacrylate (PMMA) Cement for Stabilizing Loosened Screws in Mandibular Angle Fracture Fixation: A Biomechanical Study

Aim: Mandibular angle fractures account for 23-42% of all mandibular fractures, with treatment options often debated due to the region's anatomical complexity. While single miniplate fixation has shown low complication rates, issues like screw loosening remain a challenge. Polymethylmethacrylate (PMMA) has been widely used in orthopedic surgery to improve screw stability. This study aimed to evaluate the effect of PMMA on the stability of loosened screws in mandibular angle fractures. Material and Method: Twenty hemimandibles from sheep cadavers were divided into control and experimental groups. In the control group, standard 2.0 mm screws were inserted without PMMA augmentation. In the experimental group, a 1.6 mm pilot hole was used to simulate screw loosening, and PMMA was injected into the screw tracts before screw insertion. Both groups underwent vertical force testing using a hydraulic device, with displacement values measured at 50 N of force. Statistical analysis was performed using the Student t-test, with significance set at p

Diagnostic value of thromboelastogram and thrombus molecular markers in early detection of deep vein thrombosis in patients with lower extremity fracture

BackgroundDeep vein thrombosis (DVT) is an obstructive disease with a hindering venous reflux mechanism. The aim of this study was to identify independent risk factors for deep vein thrombosis (DVT) in patients with traumatic lower extremity fractures and assess the diagnostic value of thromboelastogram (TEG) and thrombus molecular markers.MethodsReviewed patients with lower extremity fractures were admitted from October 2022 to September 2023. DVT was screened using color Doppler ultrasonography postoperation. Patients were categorized into two groups: those with DVT (n = 61) and those without (n = 191). Logistic regression was utilized to analyze DVT risk factors in these patients, and the diagnostic effectiveness of each marker was determined using the receiver operating characteristic curve (ROC curve).ResultsSignificant differences were found in the incidence of hip (44.8%), and tibia (16.4%) fractures in the DVT groups (P < 0.001). Elevated levels of tPAIC, PIC, sTM, TAT, APTT, and TEG parameters (angle, MA, and CI) were observed in the DVT group (P < 0.05). Multivariate logistic regression revealed that PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture were significant risk factors for DVT.ConclusionsPatients with hip fractures showed a higher incidence of perioperative DVT. Factors such as PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture significantly contributed to the risk of DVT in traumatic lower limb fractures. Both thromboelastogram and thrombus molecular markers demonstrated strong diagnostic capabilities in the early detection of DVT, with comparable diagnostic efficiency.

Osteosynthesis of mandibular angle fracture: Clinical case report

Maxillofacial trauma is intrinsically linked to a variety of physical injuries that compromise the anatomical structures of the upper, middle, and lower thirds of the face. In this context, the mandible stands out as one of the regions with the highest incidence of fractures in traumatic events. The objective of this study was to report a clinical case of mandibular fracture, detailing the step-by-step process from initial care to surgery to restore function and postoperative follow-up. This is an exploratory, descriptive, and qualitative case report. Data collection and use for the study were carried out following established ethical principles, in accordance with the international guidelines of the Declaration of Helsinki. The article describes the management of a mandibular fracture case resulting from a bicycle fall. After clinical diagnosis and completion of complementary and preoperative imaging tests, the patient underwent open reduction with internal fixation and was discharged the day after the procedure, without postoperative complications. The case reinforces the importance of a thorough clinical and radiological evaluation for an accurate diagnosis and for choosing the most appropriate therapeutic approach. Early intervention and correct alignment of bone fragments provide efficient healing, improving the patient's quality of life and reducing the risk of functional and aesthetic sequelae.

Outcomes and Craniometric Analyses of the Champy Technique in the Treatment of Mandibular Angle Fractures: A Retrospective Study.

The aim of this study is to examine the outcomes of superiorly placed monocortical single miniplate fixation in the treatment of mandibular angle fractures and evaluate treatment efficacy through craniometric measurements. Postoperative craniometrics were compared with both the preoperative measurements and the control group. Thirty-four patients were included with a mean follow-up of 3.1 years. Complications were observed in 6 patients, with 4 treated surgically and 2 managed nonoperatively. In the craniometric analyses, there was no significant difference between the preoperative and postoperative measurements of the gonial angle and condyle-midsagittal plane distance on both the fracture side and the contralateral side. The only significant difference was found in comparison of the degree of the mentum deviation (P=0.001). Postoperative mandibular morphometry was comparable to that of the control group. Single miniplate fixation corrects mentum deviation without resulting in any changes in condyle position and can achieve healthy mandibular morphometry.

IMPLEMENTATION OF AN OCCLUSAL WAFER IN SEVERE MANDIBULAR FRACTURE CASES WITH POST-ORIF MALOCCLUSION: A CASE SERIES

Highlights: This study shows that occlusal wafers can effectively correct malocclusion in patients with segmental mandibular fractures after ORIF plating. Occlusal wafers help reshape the dental arch within 2 to 4 weeks, reduce surgery time, and simplify follow-up care, making them a valuable option for surgeons. Abstract: Introduction: Improper treatment of severe mandibular fractures can lead to malocclusion, which poses a significant challenge for reconstructive surgeons. The occlusal wafer provides an effective solution for managing malocclusion following ORIF plating of maxillofacial fractures during the one-month postoperative evaluation period. Made from acrylic resin, the occlusal wafer serves as an intermediate guide in orthognathic surgery. It helps reposition the maxilla, adjust the mandible, and modify the jawbones to achieve ideal occlusion. The device can reshape the dental arch to any pre-planned position within 2 to 4 weeks. Case Illustration: We present two cases of patients with segmental fractures.Case 1: A 26-year-old male also had segmental fractures of the left angle and right body of the mandible. He achieved occlusion after ORIF plating; however, malocclusion developed during the three-week follow-up. Case 2: A 28-year-old female presented with segmental fractures of the left angle and right body of the mandible. She initially achieved occlusion after ORIF plating, but malocclusion was noted during the one-month follow-up. Discussion: Both of these patients had segmental fractures and experienced malocclusion following ORIF plating, but occlusion was achieved after occlusal wafer installation. Conclusion: The use of an occlusal wafer facilitates optimal occlusion, streamlines the surgical procedure by reducing operating time, and enhances the ease of postoperative monitoring. This approach proves particularly valuable in cases where ORIF plating has been performed yet ideal occlusal alignment remains unachieved.

Evaluation of the Clinical Outcomes of the Berger-Tenenhaus Approach for Open Reduction and Internal Fixation of Mandibular Fractures

ABSTRACT Introduction: The aim of this study was to evaluate the clinical outcomes, such as duration of surgery, ease of surgical access for fixation, injury to branches of the facial nerve, and scar assessment encountered on using the Berger-Tenenhaus approach for open reduction and internal fixation (ORIF) of subcondyle, ramus, angle, and body fractures of mandible. Materials and Methods: This was a prospective clinical study. Patients were selected based on inclusion and exclusion criteria. Seventeen patients in the age group above 18 years were included in this study. All patients were treated under general anesthesia using Berger-Tenenhaus approach for ORIF. The surgical outcomes were evaluated with follow-ups conducted at 24 hours, 1 week, 1 month, and 6 months. Results: The results indicated that the average duration of surgery was 34.47 ± 7.383 minutes with good access to fracture sites and inconspicuous scars at the 6th month. There were no cases of facial nerve paralysis. Conclusion: This study concludes that the Berger-Tenenhaus approach is an effective and safe technique for ORIF of mandibular fractures, such as subcondyle, ramus, body, and angle. This approach has less duration of surgery with good access, no morbidity to the facial nerve, and provides cosmetic results.

84 “Taking off” with propellar plates – A review of alternatives for mandibular angle fractures

84 “Taking off” with propellar plates – A review of alternatives for mandibular angle fractures

Comparative Evaluation of the New Angled Miniplate (Banana Plate) with the Conventional Miniplate for Management of Mandibular Angle Fracture

ABSTRACT Introduction: Mandibular angle fractures (MAFs) are divisive and have led to debate in terms of treatment. The study evaluated the new angled miniplate (banana plate) with the conventional miniplate for management of MAFs. Patients and Methods: The study included 53 patients of MAFs, 26 treated with the conventional miniplate (control group) and 27 with the angled miniplate (study group). The patients were followed up and evaluated for 6 months for mouth opening, bite force, and complications. Results: A longer operating time was noted in the study group. The mouth opening and bite force were higher in the study group with fewer postoperative complications. Conclusion: The new angled miniplate mimics the angle of the mandible and offers better tridimensional stability, fewer complications, and improved stability.

Clinical Outcomes of Mandibular Angle Fractures Treated by Single-Versus Double Miniplates

Clinical Outcomes of Mandibular Angle Fractures Treated by Single-Versus Double Miniplates

Three-dimensional V-shaped plate versus two conventional miniplates for treatment of mandibular angle fracture (Randomized controlled clinical trial)

Three-dimensional V-shaped plate versus two conventional miniplates for treatment of mandibular angle fracture (Randomized controlled clinical trial)

Does the Method of Open Reduction and Internal Fixation of Mandibular Angle Fracture Differentially Affect Postoperative Strength of Jaw Muscles as Assessed by Surface Electromyography? An Analytical Study

Does the Method of Open Reduction and Internal Fixation of Mandibular Angle Fracture Differentially Affect Postoperative Strength of Jaw Muscles as Assessed by Surface Electromyography? An Analytical Study

Prevalence of Traumatic Dental Injuries and Associated Risk Factors Among Preschool Children in Goa: A Cross-Sectional Study.

Primary teeth trauma has received very little attention compared to permanent teeth due to their eventual exfoliation. Enamel discolorations, hypoplasias, and enamel-surface abnormalities have been reported in the permanent dentition following primary tooth trauma. Traumatic dental injuries (TDI) also have an impact on the quality of life of an individual. The study aims to determine the prevalence of TDI and its association with various risk factors in preschool children in the state of Goa. The primary objective is to determine the prevalence of TDI in primary anterior teeth in preschool children in the state of Goa. The secondary objective is to determine the association of various risk factors with TDI in preschool children in the state of Goa. A cross-sectional survey was conducted among preschool children aged three to five years across the state of Goa. A total of 971 children were included in the study. Parents or guardians of participants who reported trauma answered an interview addressing the history of the injury. The anterior dental trauma and associated factors such as age, gender, time of injury, month of injury, place of injury, occlusal relationship, lip competence, oral habits, and ordinal position of the child were assessed and analyzed. Out of the 971 children examined, TDI was reported in 157 (16.1%) children. Of these, 83 of 157 (52.8%) children had experienced TDI at home. Three-year-old children had the highest TDI prevalence of any age group, with 32 of 145 (22.0%) experiencing TDI. The most commonly affected tooth (100 of 233, 10.3%) was the primary maxillary right central incisor. Of the 233 traumatized teeth, 100 (42.9%) had code 2 injuries (enamel fractures only), which were the most frequently reported injuries. Mesio-incisal angle fracture was detected in 84 (34.3%) teeth affected with TDI. With respect to the number of teeth traumatized, 99 of 157 (63.0%) of children had a single tooth traumatized. Among all children who had sustained TDI, 103 (65.6%) were firstborns, 50 (31.8%) were secondborns, and four (2.5%) were thirdborn children. Only eight children received treatment, of which seven received medications and only one child received dental treatment. Parents being unaware of TDI was the main reason for not seeking treatment. This study highlights the critical need for educating parents and teachers about TDI prevention and the importance of prompt dental care. The findings offer valuable insights for formulating state- and national-level policies and preventive strategies for managing TDI.

Is it safe to treat osteoporotic burst thoracolumbar fracture using percutaneous vertebroplasty? A minimum of 5-year follow-up study

BACKGROUND CONTEXTPercutaneous vertebroplasty for the treatment of osteoporotic burst fractures remains controversial. A previous study has shown that an osteoporotic burst fracture with asymptomatic spinal canal compromise is not a contraindication for percutaneous vertebroplasty. PURPOSETo determine whether these outcomes persist over a long term, we continued to observe patients in their short-term study over a long-term period. STUDY DESIGNProspective study. PATIENT SAMPLEPatients with osteoporotic vertebral fractures were classified as Dennis type I and II and AO type A1-A4, and no neurological deficits were observed. OUTCOME MEASURESOswestry disability index and visual analog scale (VAS11VAS, visual analogue scale.) for pain were outcome measures. Radiological outcomes were vertebral body height and kyphotic angle. Complications included cement leakage, adjacent fractures, and transition to instrumented fusion. METHODSBetween June 2015 and December 2016, 96 patients with osteoporotic vertebral fractures who met the inclusion criteria were prospectively enrolled. Preoperative, postoperative, and latest follow-up clinical outcomes were assessed using the Oswestry disability index and VAS. The radiological outcomes included vertebral body height, kyphotic angle, and adjacent fractures. Patients with intractable pain and neurological deficits during the follow-up were indicated for surgical treatment using decompression and instrumented fusion. RESULTSFifty-one patients with osteoporotic compression fractures and 45 with osteoporotic burst fractures were included in this study. Mean follow-up duration was 74 months, and posterior vertebral body height, kyphotic wedge angle, and VAS score were not altered during the follow-up period. Three (5.9%) patients in an osteoporotic compression fracture group and three (6.7%) in a osteoporotic burst fracture group developed persistent pain, further collapse, and neurological deficits, and were indicated for surgical treatment. No significant differences were observed in the rates of adjacent fractures. Percentage of patients who required surgical treatment was not significantly different between the groups. CONCLUSIONSOsteoporotic burst fractures with asymptomatic spinal canal compromise treated with percutaneous vertebroplasty are safe and effective for pain management during long-term follow-up.

Treatment of Comminuted Mandibular Angle Fractures Using Champy Technique.

Isolated and noncomminuted mandibular angle fractures are commonly fixed with a single miniplate on the superior border (Champy technique) through an intraoral approach. However, the use of this technique for comminuted mandibular angle fractures has not been reported yet. This article verified that the Champy technique can also be used to treat comminuted mandibular angle fractures. The authors compared the therapeutic effects of using the Champy technique for intraoral fixation of comminuted mandibular angle fractures with or without alveolar bone defect. The dislocated teeth were removed. Iodoform gauze was used in a patient with alveolar bone defects and incomplete closure of soft tissue. A patient with comminuted mandibular angle fractures without alveolar bone defect experienced primary wound healing and good occlusion after surgery. A patient with comminuted mandibular angle fractures accompanied by alveolar bone defect and incomplete closure of soft tissue has an intraoral fistula and bone resorption until 2 months postoperatively. At 6 months postoperatively, the occlusion remained stable and callus healing had been completed. The Champy technique for intraoral single plate fixation is feasible for comminuted mandibular angle fractures. Incomplete closure of soft tissue leads to exposure of the bone marrow cavity, resulting in delayed fracture healing.

Comprehensive analysis of the effect of braiding angle on the wettability and mechanical properties of 3D braided carbon fiber fabric-reinforced composites

Fiber-reinforced composites are designed to enhance strength, stiffness, and lightweight properties. However, while the use of continuous fibers offer substantial performance benefits it presents challenges in achieving complex configurations. This study focused on evaluating the effects of different braiding angles on the mechanical properties of braided fabric-reinforced composites (B-CFRP). Continuous fiber tows were braided around a mandrel, with meticulous control over the key process parameters to ensure consistency. The composites were then processed using the Vacuum Assisted Resin Transfer Molding (VARTM) technique to achieve optimal impregnation of the resin. Mechanical properties, including tensile, flexural, compressive strength, interlaminar shear strength (ILSS), and impact strength, were performed to establish the relationship between resin impregnation and mechanical properties with different braid angles. Additionally, resin flow experiments and scanning electron microscopy (SEM) analysis were conducted to investigate how variations in braiding angle influence fiber arrangement, resin distribution, and fracture behavior. These insights aim to guide the design and manufacturing of high-performance composites.

A novel method for evaluating shale gas preservation conditions in an area on a regional scale

The Youjiang Basin is the main area of the Middle Devonian shale gas resources in southern China, with complex geological conditions, diverse stratigraphic structures, low level of exploration and limited hydrocarbon geological data. In this study, a method is proposed for evaluating the regional shale gas preservation conditions, by which it is easy to obtain information (using available data from regional geological maps) and to process data (processed by computer software). This method was applied to the evaluation of the preservation conditions of the Middle Devonian shale gas in the Youjiang Basin. Information extracted from geologic maps includes exposed stratum, magmatic rock distribution, stratigraphic occurrence and surface fracture distribution. Evaluation criteria for three indexes (stratigraphy index, dip angle index and fracture index) were established to classify the preservation conditions into five types from good to bad. Based on the calculated values of comprehensive index (CI), the comprehensive evaluation each area: 11621.23 km2 for CI of 0.7–1.0, 37162.67 km2 for CI of 0.5–0.7, 57784.43 km2 for CI of 0.3–0.5, 69303.77 km2 for CI of 0.1–0.3, and 69303.77 km2 for CI of 0.0–0.1, accounting for 3.19%, 10.19%, 15.84%, 18.99% and 51.80% of the whole area, respectively. These results are highly consistent with the actual exploration discoveries, showing that in the northern and central parts of the Guizhong Basin, the southern part of the Xidamingshan Uplift, and the northern part of the Qiannan Basin, there are large areas with good shale gas preservation conditions.

Diagnostic Utility of the "Air Sign" as a Radiological Indicator for Mandibular Body and Angle Fractures.

Background: To plan optimal treatment, obtain satisfactory outcomes, and avoid undesirable clinical errors, surgeons need to have efficient tools for providing a complete and prompt diagnosis. The aim of this study was to establish the sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate of the "air sign" (AS) within soft tissues as an indirect radiological indicator of mandibular body and angle fractures. Methods: A retrospective analysis of preoperative computed tomography (CT) and cone beam computed tomography (CBCT) scans was performed on patients with mandibular fractures within a three-year period. Two fracture types were analyzed: open and closed fractures. Results: Forty-three patients with a total of 71 mandibular fractures were included in the study. The mean age of the patients was 35 years, and the majority were male (83.7%). The sensitivity of the AS was 92.2%, specificity = 90.0%, positive predictive value = 95.9%, negative predictive value = 81.8%, false positive rate = 10.0%, and false negative rate = 7.8%. Higher values were observed for open fractures compared to closed fractures. Conclusions: The sensitivity and specificity of AS are lower than those of OPG, CT, and CBCT. However, AS offers an important additional radiological indicator that can effectively reduce the risk of misdiagnosing mandibular body and angle fractures.

Three-Dimension Grid Plate Effecting in Mandibular Fracture Fixation

Introduction: The mandibular angle fractures in the region of the body represent the highest incidence of fractures in mandibles and therefore deserve special attention and care. The use of three-dimensional plates has shown good results in this type of treatment and use has increased every day. Case Report: The authors describe two cases of mandibular fractures treated with grid miniplate. In case 1, was carried out extra-oral access for fracture reduction in angle. In case 2 was also carried out extra-oral access for fracture reduction in mandibular body. The monitoring showed the surgical success and the absence of postoperative complications. The grid miniplate has shown a great treatment option in cases of fractures of the mandibular body and angle for ease of use and lower rates of postoperative complications. Conclusion: The use of a three-dimensional grid plate has proven to be a viable alternative for the osteosynthesis of mandibular fractures. The results have significant clinical implications and encourage its use.

Evaluation of Screw and Wire Traction in Anatomic Reduction of Mandibular Fracture

Abstract Background Displaced mandibular fractures have numerous ways of being reduced, the aim of adequate fracture reduction is to achieve good bone contact to allow for adequate healing. Reduction techniques include, bone holding forceps, manual reduction and reduction using IMF techniques which restore occlusion and then secondarily reduce the fracture site. Fracture immobilization using rigid fixation then follows reduction thus maintaining adequate bone contact allowing fracture line healing. The use of screw and wire traction provides stable fracture reduction anatomically without the need for IMF. Aim of the Work The aim of this study is to evaluate the efficacy of screw and wire traction in anatomical reduction of mandibular fracture on the accuracy of reduction, operative time and post-operative pain and edema. Patients and Methods This is a single arm interventional clinical trial including twenty adult individuals with mandibular fractures. Patients who are fulfilling the inclusion criteria of our study were sampled randomly. Results Twenty cases were included in our study. Adequate fracture reduction was done in all patients with good clinical bone contact and with good post-operative CT results, post-operative pain and edema were minimal due to decreased manipulation of the fracture and the simplicity of the technique. The occlusion of the patients was followed up 2 and 6 weeks post operatively with cases showing no occlusal disturbance and return to normal function within 3 months. Conclusion Screw and wire traction for reduction of mandibular fractures anatomically showed success as regards to fracture reduction and showed no occlusal complication, we recommend this technique specially in symphyseal, paranymphs and angle fracture. The fracture line taking a strictly vertical axis shows the best outcome, however multiplanar fracture lines or L-shaped fractures are not good specimens for this method of reduction.