Management Of Mandibular Fractures Research Articles

Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing

The clinical finite element analysis (FEA) application in maxillofacial surgery for mandibular fracture is limited due to the lack of a validated FEA model. Therefore, this study aims to develop a validated FEA model for mandibular fracture treatment, by assessing non-comminuted mandibular fracture fixation. FEA models were created for mandibles with single simple symphysis, parasymphysis, and angle fractures; fixated with 2.0 mm 4-hole titanium miniplates located at three different configurations with clinically known differences in stability, namely: superior border, inferior border, and two plate combinations. The FEA models were validated with series of Synbone polymeric mandible mechanical testing (PMMT) using a mechanical test bench with an identical test set-up. The first outcome was that the current understanding of stable simple mandibular fracture fixation was reproducible in both the FEA and PMMT. Optimal fracture stability was achieved with the two plate combination, followed by superior border, and then inferior border plating. Second, the FEA and the PMMT findings were consistent and comparable (a total displacement difference of 1.13 mm). In conclusion, the FEA and the PMMT outcomes were similar, and hence suitable for simple mandibular fracture treatment analyses. The FEA model can possibly be applied for non-routine complex mandibular fracture management.

Outcome Study of Mandibular Fractures Treated by Surgical Stabilization With Plates and Screws.

This study aims to assess the outcomes of mandibular fractures treated through surgical stabilization using plates and screws, focusing on factors such as postoperative complications, patient satisfaction, and functional recovery. A total of 42 patients were included in the study. Surgical interventions involved the application of plates and screws at the fracture sites. Postoperative complications, including infection, hardware failure, and malocclusion, were recorded. Surgical stabilization of mandibular fractures using plates and screws demonstrates favorable outcomes in terms of stability, occlusal alignment, and patient satisfaction. The findings of this study contribute valuable insights into the efficacy of this surgical approach, highlighting its role in achieving successful outcomes for mandibular fracture management. Further prospective studies and randomized controlled trials are recommended to strengthen the evidence base and refine treatment protocols.

Efficacy of the titanium double ‘Y’- shaped mini plate compared with conventional mini plates in fixation of anterior mandibular fractures: A prospective clinical study

: Anterior mandibular fracture management is commonly dealt in oral and maxillofacial surgery and most accepted treatment modality is open reduction and internal fixation with miniplates. With ongoing research, various shapes of miniplates were tried for osteosynthesis and biomechanical properties tested in invitro studies, but they lack testing in clinical scenarios. The present study was conducted to compare clinically and radio graphically, the efficacy of double Y-shaped mini plate with two conventional 4 hole mini plates in management of anterior mandibular fractures. : Study consisted of 20 patients, 10 in each group with anterior mandibular fractures. 10 patients (group 1) were treated with double ‘Y’ shaped miniplate with bar and 10 patients (group 2) with conventional 4 hole two miniplates. Clinically post-operative Pain, edema, occlusion, neurosensory deficit and wound healing were assessed. Clinical evaluation was done at 1st postop day, 1st week, and 1st and 3rd month postoperatively. Radiographic evaluation was done to record fracture gap in both the groups and timing for plate adaptation and fixation was recorded intra-operatively. The data was recorded and statistical analysis was done.: Clinical and radiographic evaluation done for each group did not show any statistical difference at 3 months postoperatively. However significant difference was noted in time taken for adaptation and fixation of plates and screws. Double ‘Y’ shaped miniplate was found to be easier to place and required less time to adapt and fix to bone compared to 4-hole miniplates. The study concluded that the double ‘Y’ miniplate and conventional 4-hole miniplates are found to be equally effective for clinical use in treatment of anterior mandibular fractures. The double ‘Y’ miniplate were found to be superior in terms of handling characteristics, less hardware and better radiographic outcome when compared to conventional 4-hole miniplates.

Objective assessment of the factors affecting outcome of immediate management of mandibular fractures – A prospective study in a Level-I trauma care center

Background: Mandibular fractures lead to complications if improperly treated. The management of mandibular fractures includes open reduction and internal fixation (ORIF) or closed reduction. Associated complications include malocclusion, infection, hardware extrusion, and nerve injury. Aims and Objectives: The aims of this study were to evaluate the functional outcome of various treatment modalities of mandibular fracture and to identify the factors affecting the outcome. Materials and Methods:The study included patients admitted in the trauma care center, between 13 and 70 years of age, and having mandibular fracture. Patients underwent ORIF or closed reduction according to the type of fracture. Mandibular injury severity score (MISS), Mandibular functional impairment questionnaire (MFIQ) score, and pain visual analog score were used to assess the functional outcome of treatment and complications. Results: Majority of the patients were male and were in the age group 21–30 years. The most common cause of fracture was road traffic accident (RTA). Majority of the patients underwent ORIF. Patients having higher injury severity scores, severe MFIQ scores and pain visual analog scores had more complications. Overall, complications in open reduction cases were higher than closed reduction ones. However, weight loss and time to functional improvement were more in closed reduction cases. Conclusion:Young males are most commonly affected with fracture of mandibles and mostly due to RTAs. There should be minimal delay from presentation to operative intervention in case of patients who require ORIF. Scoring systems such as MISS, MFIQ, and pain visual analog scale scores may help in the early prognostication of injury and warn against imminent complications.

P077 A five-year review of the management of mandibular fractures in a non-trauma centre

P077 A five-year review of the management of mandibular fractures in a non-trauma centre

How good is good enough? Lessons learned from review of outcomes of 50 patients following extraoral open reduction and internal fixation of condylar neck and base fractures at a regional major trauma centre

The management of mandibular fractures is routine owing to their frequency, particularly those of the mandibular condyle, which are invariably common. Notwithstanding disparities in the literature, the international consensus towards which fractures of the mandibular condyle benefit from open surgical intervention is almost universally accepted. Closed reduction or non-operative management may be utilised in certain circumstances. Whilst outcome research has addressed complications with respect to operative side effects, outcomes related to the quality of bone repair and the setting in which this is delivered have not been universally addressed. The aim of this study was to determine the predictability of translating an indicated operative treatment plan into an acceptable functional result. We evaluated the outcomes of 59 extracapsular condylar fractures in 50 patients who were treated by extraoral open reduction and internal fixation (ORIF) between March 2021 and August 2022. We reviewed demographic data, surgical approach, and plating strategy, and critically evaluated the clinical and radiological outcomes. Whilst we found that the quality of reduction was not universally perfect, the majority were within tolerance, which we set according to the Strasbourg Osteosynthesis Research Group (SORG) definition for minimal displacement (<2 mm overlap and 10° angulation). The cohort had good functional occlusion and minimal long-term postoperative complications. Two patients required re-operation for non-union, and we discuss causality in these cases. In conclusion, we found that ORIF of condylar neck and base fractures is predictable in real-time surgical practice with respect to functional outcome. However, if imperfectly reduced, there is a small risk of non-union.

Compare between intraorala and extraoral approaches of subcondylar mandibular fracture management

Background: Mandibular fractures, including fractures of the subcondylar and condylar regions, are common facial fractures. Sub condylar fractures account for 20–62% of all mandibular fractures. But their management remains controversial. Although closed reduction is the most useful method, it can be difficult to achieve anatomical reduction with this technique compared with open reduction and internal fixation (ORIF). Aim of the work: To compare between intraoral and extraoral approaches in management of submandibular fracture. Patients and methods: This comparative study was conducted in the plastic surgery department, Faculty of medicine-Menoufia University on 20 patients complaining of sub condylar fracture of mandible. Patients were classified into two groups based on surgical approach: Group A: included ten patients undergoing surgical fixation via the intraoral approach. Group B: included ten patients undergoing surgical fixation via extraoral approach Group. Results: A statistically significant difference was found between groups regarding operating and time. Intraoral approach had a signifcanlty longer operating time compared to extraoral. A statistically significant difference was found between groups regarding interincisal distance. Intraoral approach had a significantly larger interincisal distance compared to extraoral approaches. A statistically significant difference was found between groups regrading field of exposure extraoral have wide field of exposure.

A CONSERVATIVE APPROACH TO PAEDIATRIC MANDIBULAR FRACTURE MANAGEMENT

Mandibular fractures can be considered as less frequently in children than in adult population, but when considered in children, it’s one of the commonest fractures. This less occurrence is mainly due to protective anatomical features. Treatment for pediatric mandibular fractures remains controversial and differs from that of adults. Management is extremely complicated due to developing mixed dentition. The treatment modalities lay in a wide range from conservative management to surgical options. A case of eight-year-old girl with fractures in mandibular ramus and parasymphyseal region that was managed conservatively and kept under observation is presented. This report provides a review of literature regarding the management of mandibular fractures in pediatric patients.

Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire

PurposeThe purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire.MethodsA retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi’an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient’s medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients.ResultsOut of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed.ConclusionThe treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.

Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients.

To assess the diagnostic and therapeutic approaches in pediatric mandibular fractures with regards to fracture pattern and localization. This retrospective study included patients under the age of 17 years that presented to the Department of Oral and Maxillofacial Surgery at Charité-Universitätsmedizin Berlin with mandibular fractures over an 11-year long period (2010-2020). Medical records were analyzed for age, gender, injury mechanism, clinical presentation, imaging modalities, fracture pattern, and fracture management. Statistical analyses included descriptive statistics, normality testing, and Mann-Whitney U tests. A total of 91 pediatric patients (23 females and 68 males) presented with mandibular fractures. The majority of mandibular fractures occurred in patients aged 13-16 years (67.0%, n = 61). The main causes were activities of daily life (34.1%), followed by assault (25.3%). Malocclusion and pain upon mandibular joint compression were documented in 72.5% and 51.7% of patients, respectively. The most frequently applied radiological diagnostic tool was a panoramic X-ray (49.5%). The main fracture patterns were single (42.9%) and double fractures (48.4%). An age-adapted surgical approach using open reduction and internal fixation (ORIF) was the most frequent management (61.5%). A conservative approach was favored in cases of condylar head fractures. Resorbable plates were used in eight cases of ORIF (8.8%). Treatment regimens should be carefully selected based on the unique anatomy of the pediatric patient with regards to centers of growth and dentition phase, to restore stomatognathic function and to maintain adequate skeletal growth and eruption of teeth. This study illustrates the challenges of mandibular fracture management in the pediatric patient. Hofmann E, Koerdt S, Heiland M, et al. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients. Int J Clin Pediatr Dent 2023;16(3):499-509.

Comparison Between Repositioning Reduction Forceps and Intermaxillary Fixation with Eyelets in Anterior Mandibular Fracture Management

Road traffic mishaps, lack of organized health-care facilities, and inadequate referral and transportation, particularly in rural regions, are boosting anterior mandibular fracture incidence. Objective: To compare the outcome of repositioning reduction forceps and Intermaxillary fixation (IMF) with eyelets in the anterior mandibular fracture management. Methods: Seventy consecutively sampled patients with isolated mandibular fractures were divided into two groups. IMF with eyelets was utilized to reduce mandibular fractures in group A and repositioning reduction forceps was used in group B. After mini plating, IMF was removed. Two observers assessed postoperative bony alignment, occlusion, lingual flaring and nonunion based on radiographs and findings. Results: Group A included 24 (68.6%) and 29 (82.9%) male patients, whereas group B had 11 (31.4%) and 6 (17.1%) female patients with mean ages of 27.9 ± 6.9 and 27.8 ± 8.9 years. In postoperative assessment, bony segments alignment (reduction) day-21 was present in all patients, lingual flaring at day-21, 1 (2.9%) and 2 (5.7%) patients, gap in fracture segments at day 21 was &gt; 5mm in all subjects, malocclusion at day 21, 0 (0.0%) and 1 (2.9%) in group A and B respectively. Day 21 showed no non-union in any group. Conclusions: IMF with eyelets and repositioning reduction forceps improves bone segment alignment (reduction), lingual flare, fracture gap, and malocclusion.

Can Fracture Reduction be Attempted Through a 3D-Printed Guide Template Without Maxillomandibular Fixation?

Computer-aided design and manufacturing is widely used in clinical practice. This technology may change existing methods for mandibular fracture management. The purpose of this in-vitro study was to determine if the reduction for mandibular symphysis fracture is performed without maxillomandibular fixation (MMF) using 3-dimensional (3D)-printed template. This was an in-vitro study and had the character of a proof-of-concept study. The study was planned using the existing 20 pairs of intraoral scan and computed tomography data. The mandibular model STL file was created by merging the STL file obtained for the bimaxillary dentitions with the computed tomography DICOM file, and this was set as the original model. In the original model, STL file of fracture model of mandibular symphysis was created using computer-aided design. A template similar to a wafer or an implant guide was manufactured from restoring the own occlusion, and the mandibular fracture model was reduced and fixed using the 3D-printed template and wire, and this was set as the experimental group. The 3D coordinate system error was measured at 6 landmarks and statistically compared using scan data between models of the groups. Reduction techniques with MMF or without MMF using guide template for mandibular fracture model. The 3D coordinate system error (mm). The position of landmarks. The Mann-Whitney U test, student's t-test, and the Kruskal-Wallis test were used to analyze the coordinate errors between the landmarks. A P value of < .05 was considered statistically significant. The 3D error value of the control and experimental group were 1.06±0.63mm (range: 0.11 to 2.92mm) and 0.96±0.48mm (range: 0.2 to 2.95mm), respectively. There was no statistical difference between the control and experimental group. There was a statistically significant difference in the lower 2 and lower 3 landmarks compared to the upper 1 (P=.001 and .000, respectively) before and after the reduction in the experimental group. This study demonstrates that the reduction using a 3D-printed guide template for the mandibular symphysis fracture could be possible even without the MMF.

Quality of Life Evaluation of Postsurgical Mandibular Fracture Patients with Oral Health Impact Profile 14 and General Oral Health Assessment Index Parameters.

Mandibular fracture is the most common maxillofacial fracture accompanied by complaints of malocclusion and pain. This causes a decrease in the quality of life. Mandibular fracture management can be done with open reduction and internal fixation or intermaxillary fixation. The Oral Health Impact Profile (OHIP 14) and the General Oral Health Assessment Index (GOHAI) were used to evaluate the quality of life after surgical treatment based on the distribution of age, sex, type of neglect, and surgical management. This research is an analytic study with an analytical observational method with total sampling. The total sample used was 15 patients during the 2006 to 2020 period. The results of this study were scored, and then, the data were processed using the eta test. The results of the study based on the OHIP 14 parameters showed the results of each distribution, namely, age: p = 0.154, gender: p = 0.080, neglected type: p = 0.080, and management: p = 0.419. Meanwhile, the GOHAI parameters showed the results of each distribution, namely, age: p = 0.105, gender: p = 0.356, neglected type: p = 0.356, and management p = 0.286. The results of this distribution showed that there was no significant difference between patients' quality of life based on age, sex, neglected type, and treatment using both OHIP 14 and GOHAI parameters. The results obtained in this study using characteristics of age, gender, type of fracture, type of neglect, and management did not have a significant effect on the level of patient satisfaction after surgery, using both OHIP 14 and GOHAI questionnaires.

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review.

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

Management of Mandibular Fracture Using Lateral Compression Splint in a Pediatric Patient

Management of Mandibular Fracture Using Lateral Compression Splint in a Pediatric Patient

Management of mandibular fracture and lacerated wound due to machete trauma in children: case report

Introduction: The facial fractures in pediatric patients are rare, and they need an immediate treatment to recover the function and aesthetic to the young patients. Anatomic reduction along with rigid skeletal stabilization is mandatory until bone union has occurred. Special consideration about variation in anatomy and physiology of pediatric patients, as well as the particular stage of growth and dental development should be preferred. Case report: We present a case of 5 year old girl patient with fractures of the parasymphyseal and left angle of mandible horizontally and vertically unfavourable, with significant displacement and huge lacerated wound of the face caused by machete slashed. We successfully managed the pediatric complex mandible fractures by performing open reduction internal fixation using resorbable miniplates and gunning splint as intermaxillary fixation. Conclusion: Pediatric mandible fractures requiring ORIF are rare. The combination of intermaxillary fixation and resorbable fixation system is needed postoperatively because of the extensive fractures for adequate fixation and good outcomes.

BIOMECHANICAL EVALUATION FOR COMPARISON OF 3D TITANIUM MINIPLATES WITH CONVENTIONAL TITANIUM MINIPLATES IN THE MANAGEMENT OF MANDIBULAR FRACTURES

Aim of the Study:The aim of the study was to evaluate and compare the efficacy of the 3-dimensional titanium miniplates against conventional titanium miniplates in the management of mandibular fractures. Materials and Method:This study included 20 cases of either trauma, reconstructive or orthognathic surgery in which internal fixation is indicated. Patients were assigned to any one of the two equal groups randomly. Group A consisted of 10 patients treated by 3-dimensional titanium miniplates and group B consisted of 10 patients treated by conventional titanium miniplates. Intra-operative parameter included operating time of both the groups. Postoperative clinical examination was carried out on the 1st, 2nd, 3rd, 4th, 6th weeks and the 3rd postoperative month. Postoperative clinical evaluation included assessment of pain, stability, infection, bite force, wound dehiscence. The results of two groups were compared statistically. Results:A statistically significant difference was found in the operating time which was less in group A as compared to group B (p = 0.001). The bite forces recorded on 1st postoperative week were more in group A as compared to group B and were found to be statistically significant at incisor region (p=0.012), right canine region (p=0.014), left canine region (p=0.001), right premolar region (p=0.013) and left premolar region (p=0.046). No significant difference was found in other clinical parameters. Conclusion:Due to simultaneous stabilization at superior and inferior borders, operating time was relatively less. It provides three-dimensional stability at the fracture site. 3-dimensional miniplate seems to be an easy alternative to conventional miniplates.

Comparison of Self-Tapping Screws Versus Erich’s Arch Bar Wiring for Occlusion Maintenance in the Surgical Management of Mandibular Fracture: A Randomized Control Trial

Background: Conventional methods like Erich’s arch bars and eyelet wires are currently most common methods for achieving temporary inter-maxillary fixation (IMF).&#x0D; Objectives: The purpose of the present study was to compare the efficacy of Self-tapping screws over Erich’s arch bar wiring for inter maxillary fixation in the treatment of mandibular fractures.&#x0D; Methodology: This was a randomized control trial study. Study duration was one year from October 2014 to September 2015. This study involved patients with mandibular fractures aged 22 to 65 years who visited Department of Oral &amp; Maxillofacial Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. After random sampling according to inclusion and exclusion criteria surgical treatment was done by miniplate osteosynthesis. Study population were divided into two groups. In group A, temporary MMF was done with Erich’s arch bar and in group B treatment was given with self-tapping screws. The study outcomes were total time required for achieving temporary MMF, number of wire stick injury, stability of occlusion and oral hygiene index. All the parameters were measured preoperatively and postoperatively for 14 days up to removal of screws or arch bars.&#x0D; Results: The mean time taken for temporary MMF was 11.31±2.46 min with screws as compared to 84.72±14.30 min with Erich’s arch bar. Mean number of perforations were significantly more in group A. Occlusion stability was 69.2% in group A and 84.6% in group B. The mean value of plaque index in group A was 2.85±0.25 and in group B was 1.15± 0.16.&#x0D; Conclusion: In conclusion, plaque deposition was more in group A.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):175-180

Efficacy of Three-dimensional Locking Miniplates versus Three-dimensional Standard Miniplates in the Management of Mandibular Fractures - A Prospective Clinical Study.

Fifty patients were included to compare the efficacy of three-dimensional (3D) locking miniplates versus 3D standard miniplates in the management of mandibular fractures. Fifty patients were randomly allocated to either 3D locking miniplate group or 3D standard miniplate group. All patients were followed for six months to compare post-operative occlusion, stability and associated clinical complications such as wound dehiscence, infection and plate/screw fracture and mental nerve paraesthesia. All the fractures were adequately fixed when checked intraoperatively. Four patients in each group had mildly deranged occlusion, one patient in Group A and two patients in Group B had reduced stability. None of the patients had complications of non-union or malunion. In Group A, one out of 25 patients had mental nerve paraesthesia and two had wound dehiscence. Moreover, in Group B, two patients had mental nerve paraesthesia and two others had wound dehiscence. The data when compared were statistically significant (=0.05). The overall result of our study led us to the conclusion that both the plating systems were satisfactory and there is no statistically significant difference when used for open reduction and fixation in mandibular fractures. Healing was satisfactory in both groups.

Pre-adjusted Three-Dimensional Plate Employing Printing versus Conventional Plate in the Management of Mandibular Fractures - A Comparative Study.

The aim of this study was to compare the efficacy of pre-adjusted three-dimensional (3D) plating system employing 3D printing with conventional 3D plating in the management of mandibular fractures. A randomised, clinical trial was conducted where the study sample (n = 20) was divided into two groups. In Group 1, 3D plate and in Group 2, pre-bent 3D plate was fixed to the fracture site. The parameters assessed were number of bends required for adaptation, duration of fixation, pain, occlusal stability, reduction in lingual splaying and post-operative complications. Statistically significant difference was seen for the number of bends required (P = 0.000, P < 0.01) and duration of fracture fixation (P = 0.001, P < 0.01). There was statistically significant difference between the values of pain during the adaptation of 3D plate (P = 0.033, P < 0.05). The application of pre-adjusted 3D plate is superior to conventional 3D plating in terms of reducing number of bends, duration of fixation and pain during adaptation.