Miniplate Fixation Research Articles

Titanium vs PEO Surface-Modified Magnesium Plate Fixation in a Mandible Bone Healing Model in Sheep.

Titanium plates are the current gold standard for fracture fixation of the mandible. Magnesium alloys such as WE43 are suitable biodegradable alternatives due to their high biocompatibility and elasticity modulus close to those of cortical bone. By surface modification, the reagibility of magnesium and thus hydrogen gas accumulation per time are further reduced, bringing plate fixation with magnesium closer to clinical application. This study aimed to compare bone healing in a monocortical mandibular fracture model in sheep with a human-standard size, magnesium-based, plasma electrolytic-oxidation (PEO) surface modified miniplate fixation system following 4 and 12 weeks. Bone healing was analyzed using micro-computed tomography and histological analysis with Movat's pentachrome and Giemsa staining. For evaluation of the tissue's osteogenic activity, polychrome fluorescent labeling was performed, and vascularization was analyzed using immunohistochemical staining for alpha-smooth muscle actin. Bone density and bone mineralization did not differ significantly between titanium and magnesium (BV/TV: T1: 8.74 ± 2.30%, M1: 6.83 ± 2.89%, p = 0.589 and T2: 71.99 ± 3.13%, M2: 68.58 ± 3.74%, p = 0.394; MinB: T1: 26.16 ± 9.21%, M1: 22.15 ± 7.99%, p = 0.818 and T2: 77.56 ± 3.61%, M2: 79.06 ± 4.46%, p = 0.699). After 12 weeks, minor differences were observed regarding bone microstructure, osteogenic activity, and vascularization. There was significance with regard to bone microstructure (TrTh: T2: 0.08 ± 0.01 mm, M2: 0.06 ± 0.01 mm; p = 0.041). Nevertheless, these differences did not interfere with bone healing. In this study, adequate bone healing was observed in both groups. Only after 12 weeks were some differences detected with larger trabecular spacing and more vessel density in magnesium vs titanium plates. However, a longer observational time with full resorption of the implants should be targeted in future investigations.

Highly extensile approach for comminuted ulna coronoid process fractures with mini-plate fixation: a case series of 31 patients

BackgroundFor the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up.MethodsThirty-one patients diagnosed with coronoid fractures accompanied with a “terrible triad” or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded.ResultsThe mean follow-up time was 26.7 months (range, 14–60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey’s criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification.ConclusionAn anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises.

Alternate levels versus all levels mini-plate fixation in C3-6 cervical laminoplasty: a retrospective comparative study

ObjectiveThe purpose of this study is to compare radiological and clinical outcomes between alternate levels (C4 and C6) and all levels mini-plate fixation in C3-6 unilateral open-door laminoplasty.MethodsNinety-six patients who underwent C3-6 unilateral open-door laminoplasty with alternate levels mini-plate fixation (54 patients in group A) or all levels mini-plate fixation (42 patients in group B) between September 2014 and September 2019 were reviewed in this study. Radiologic and clinical outcomes were assessed. Clinical results included Visual Analogue Scale (VAS) of axial neck pain and Japanese Orthopedic Association (JOA) score. Radiographic results included cervical range of motion (ROM), cervical curvature index (CCI), and the spinal canal expansive parameters including open angle, anteroposterior diameter (APD), and Pavlov`s ratio.ResultsThere was no significant difference in VAS, JOA score, ROM, and CCI between two groups. There was no significant difference in canal expansion postoperatively between two groups. However, open angle, APD, and Pavlov`s ratio in group A decreased significantly during the follow-up. In group B, APD, Pavlov`s ratio, and open angle were maintained until the final follow-up. There was no hardware failure or lamina reclosure occurred in both groups during the follow-up. The mean cost of group B was higher than that of group A.ConclusionsDespite the differences in the maintenance of canal expansion, alternate levels mini-plate fixation can achieve similar clinical outcomes as all levels mini-plate fixation in C3-6 unilateral open-door laminoplasty. As evidenced in this study, we believe C3-6 laminoplasty with alternate levels (C4 and C6) mini-plate fixation is an economical, effective, and safe treatment method.

Surgical Complications in Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease: Experience in 800 Patients

Introduction: We present our surgical complications resulting in neurological deficit or additional surgery during 25 years of DBS of the subthalamic nucleus (STN) for Parkinson’s disease (PD). Methods: We conducted a retrospective chart review of all PD patients that received STN DBS in our DBS center between 1998 and 2023. Outcomes were complications resulting in neurological deficit or additional surgery. Potential risk factors (number of microelectrode recording tracks, age, anesthesia method, hypertension, and sex) for symptomatic intracerebral hemorrhage (ICH) were analyzed. Furthermore, lead fixation techniques were compared. Results: Eight hundred PD patients (507 men, 293 women) received unilateral (n = 11) or bilateral (n = 789) implantation of STN electrodes. Neurological deficit due to ICH, edema, delirium, or infarction was seen in 8.4% of the patients (7.4% transient, 1.0% permanent). Twenty-two patients (2.8%) had a symptomatic ICH following STN DBS, for which we did not find any risk factors, and five had permanent sequelae due to ICH (0.6%). Of all patients, 18.4% required additional surgery; the proportion was reduced from 27% in the first 300 cases to 13% in the last 500 cases (p < 0.001). The infection rate was 3.5%, which decreased from 5.3% in the first 300 cases to 2.2% in the last 500 cases. The use of a lead anchoring device led to significantly less lead migrations than miniplate fixation. Conclusion: STN DBS leads to permanent neurological deficit in a small number of patients (1.0%), but a substantial proportion needs some additional surgical procedure after the first DBS system implantation. The risk of revision surgery was reduced over time but remained significant. These findings need to be discussed with the patient in the preoperative informed consent process in addition to the expected health benefit.

Post-BSSO condylar position stability: a comparison of miniplate and lag screw fixation

BackgroundThis study was conceived to assess the postoperative stability of condylar position following fixation with miniplates and lag screws after bilateral sagittal split osteotomy (BSSO).MethodsThis retrospective study included a cohort of 20 patients undergoing BSSO using the Obwegeser-Dal Pont modification. The bony segments were stabilized using either miniplates with two 2.0-mm monocortical screws per segment or three 2.0-mm bicortical lag screws along the mandible’s superior border. Pre- and postoperative (7-day interval) spiral computed tomography scans were conducted to assess skeletal changes across both groups. Data analysis employed Wilcoxon signed-rank and Wilcoxon rank-sum tests (α = 0.05).ResultsNo statistically significant difference was observed between the pre-and postoperative condylar position parameters (P>0.05). However, the lag screw group showed a marginal significant increase in the left condyle’s angulation (preoperative: 24.83 ± 6.37 vs. postoperative: 32.5 ± 4.93; P = 0.04). Changes in condylar height, length, and width were not statistically significant before and after BSSO in either groups (P>0.05). Nor was any statistically significant difference found between the miniplates and lag screws groups regarding condylar position parameters (P>0.05).ConclusionThe results indicated that both lag screw and miniplate fixation methods can be effectively employed in BSSO procedures without impacting condylar position parameters. Thus, either fixation method can be chosen depending on factors such as the surgeon’s preference and clinical outcomes.

Comparative Biomechanical Stability of the Fixation of Different Miniplates in Restorative Laminoplasty after Laminectomy: A Finite Element Study

A novel H-shaped miniplate (HSM) was specifically designed for restorative laminoplasties to restore patients’ posterior elements after laminectomies. A validated finite element (FE) model of L2/4 was utilized to create a laminectomy model, as well as three restorative laminoplasty models based on the fixation of different miniplates after a laminectomy (the RL-HSM model, the RL-LSM model, and the RL-THM model). The biomechanical effects of motion and displacement on a laminectomy and restorative laminoplasty with three different shapes for the fixation of miniplates were compared under the same mechanical conditions. This study aimed to validate the biomechanical stability, efficacy, and feasibility of a restorative laminoplasty with the fixation of miniplates post laminectomy. The laminectomy model demonstrated the greatest increase in motion and displacement, especially in axial rotation, followed by extension, flexion, and lateral bending. The restorative laminoplasty was exceptional in preserving the motion and displacement of surgical segments when compared to the intact state. This preservation was particularly evident in lateral bending and flexion/extension, with a slight maintenance efficacy observed in axial rotation. Compared to the laminectomy model, the restorative laminoplasties with the investigated miniplates demonstrated a motion-limiting effect for all directions and resulted in excellent stability levels under axial rotation and flexion/extension. The greatest reduction in motion and displacement was observed in the RL-HSM model, followed by the RL-LSM model and then the RL-THM model. When comparing the fixation of different miniplates in restorative laminoplasties, the HSMs were found to be superior to the LSMs and THMs in maintaining postoperative stability, particularly in axial rotation. The evidence suggests that a restorative laminoplasty with the fixation of miniplates is more effective than a conventional laminectomy due to the biomechanical effects of restoring posterior elements, which helps patients regain motion and limit load displacement responses in the spine after surgery, especially in axial rotation and flexion/extension. Additionally, our evaluation in this research study could benefit from further research and provide a methodological and modeling basis for the design and optimization of restorative laminoplasties.

Treatment of Complex Central Talar Fractures with Lateral Plate Combination with Medial Screw Fixation.

The treatment of talar neck and/or body fractures is known to be difficult and challenging, with significant impact on the long-term functional outcome for the patient. The optimal management, including the choice of surgical approaches and implants, are still under constant discussion. The purpose of the study was to investigate the clinical effects of lateral mini-plate combined with medial lag screws for the treatment of complicated central talar fractures. The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system. The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%). The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon's thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.

Does adjunctive fixation in conjunction with miniplate affect condylar position and morphology after mandibular advancement through bilateral sagittal split ramus osteotomy? A retrospective 3-dimensional CT comparative study

To minimize condylar positional and morphological changes after mandibular advancement through bilateral sagittal split ramus osteotomy (BSSRO), surgeons add either a bicortical screw or a two-hole plate distal to the conventional single miniplate. Since there have been no previous studies investigating the effect of this combination, our study aimed to evaluate the short- and long-term effects of these adjunctive fixation methods (AFM) on condylar positional and morphological changes after mandibular advancement through BSSRO.This retrospective cohort study included consecutive patients with retruded mandibles who were treated in the Department of Orthognathic and TMJ Surgery at West China Hospital of Stomatology, Sichuan University. The patients were divided into two groups based on the primary predictor variable, which was the addition of AFM — either a single bicortical screw or a two-hole plate in addition to the single miniplate. The primary outcome variable was the condylar positional and morphological changes after mandibular advancement through BSSRO. Three-dimensional facial CT scans were obtained at three different time points (preoperatively — T0, 1 week postoperatively — T1, and 1 year postoperatively — T2) and analyzed using ITK-SNAP, 3D Slicer, and SlicerSALT software. Intergroup comparisons were conducted with an independent t-test, with a p-value of <0.05 considered significant. Correlations between the variables were estimated by Pearson correlation. The study comprised 51 patients (32 females, 19 males; mean age 25.13 ± 4.24 years), involving a total of 81 condyles (21 unilateral and 60 bilateral).There was a significant difference in long-term condylar displacement in favor of AFM along with a single miniplate (p < 0.001). The bicortical screw group recorded less condylar displacement than the two-hole plate group horizontally (0.11 mm vs 0.22 mm) and sagittally (0.03 mm vs 0.17 mm), but more vertically (0.85 mm vs 0.03 mm). Bone formation associated with AFM occurred on all condylar surfaces, compared with only three surfaces in the single miniplate group.The adjunctive method in addition to the single miniplate fixation method showed less condylar displacement and more bone apposition after mandibular advancement through BSSRO. The follow-up duration variable was the only significant determinant for volumetric changes in the condyle.

Evaluation of stability of fixation using conventional miniplate osteosynthesis in comminuted and non-comminuted Le Fort I, II, III fractures – A dynamic finite element analysis

Purpose: The purpose of the present study was to evaluate and compare the stability of fixation using conventional miniplate osteosynthesis in comminuted and non-comminuted Le Fort I, II, and III fractures in open and closed jaw movements under masticatory loading conditions.Materials and Methods: About 23 dimensional models of comminuted and non-comminuted Le Fort I, II, and II with traditional miniplate fixation were simulated virtually using a CT scan of the patient and analyzed using ANSYS Workbench 2020 R1 software. The dynamic finite element method was applied by the simulation of the forces of the muscles of mastication upon the fractured midface. The von Mises stress was analyzed and collated for each model; thereby, the stability of conventional miniplate fixation was interpreted.Results: The von Mises stress over the regions of fixation were compared and the tabulated data was interpreted. Considerable von Mises stress was generated on the bone and deformation over the hardware was noted on the pyriform rim in the Le Fort I model, infraorbital rim in the Le Fort II model, and frontonasal region in the Le Fort III model in the closing phase of jaw movement.Conclusion: The findings implicated that the biomechanical stability of conventional miniplate osteosynthesis is insufficient to secure the midface fractured bone under masticatory load.

The Outcomes of Mini-Plate Fixation for Unstable Wagstaffe Tubercle Fracture, an Indirect Syndesmosis Injury in Rotational Ankle Fracture.

Background: Wagstaffe fracture constitutes an indirect injury to the AITFL and can precipitate syndesmotic instability. The prevailing fixation methods often involve the use of mini-screws or K-wires, with absorbable suture repair reserved for cases with small or comminuted fragments exhibiting instability. In this study, we devised a mini-plate fixation method capable of securing the fracture fragment irrespective of its size or condition. Methods: A retrospective chart review was conducted on patients who underwent surgery for ankle fractures between May 2022 and October 2023. The surgical technique involved direct fixation of the Wagstaffe fracture using mini-plate fixation. Radiologic evaluation was performed using postoperative CT images, and clinical outcomes were assessed using the OMAS and VAS. Results: Fourteen patients with an average age of 62.5 years were included. Most fractures were associated with the supination-external rotation type. The average preoperative OMAS significantly improved from 5.95 to 83.57 postoperatively. The average VAS score decreased from 7.95 preoperatively to 0.19 postoperatively. Conclusions: The mini-plate technique for Wagstaffe fractures exhibited dependable fixation strength, effective fracture reduction, a minimal complication rate, and judicious surgical procedure duration.

The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture.

Repetitive instances of sudden injuries to the first metacarpal bone can affect thumb movement. These injuries typically occur after vertical impact to the thumb. The treatment for these injuries should focus on restoring the structure and biomechanics of the trapeziometacarpal joint, with surgery being recommended for optimal results. Bennett's fracture involves the bifurcation of the bone into two distinct fragments, characterized by a smaller fragment and a larger counterpart. Rolando fracture is associated with a fracture of the base of the first metacarpal bone, typically divided into three parts. An extra-articular fracture involves the metacarpal bone of the thumb. Conservative treatment outcomes have been found to be unsatisfactory when the fracture is displaced. Therefore, surgery methods such as minimally invasive surgery, open reduction, and arthroscopic surgery have been proven to be effective. Surgical techniques for bone procedures include pin fixation, direct screw fixation, indirect screw fixation, and mini-plate fixation. Additionally, the prognosis of this condition depends on the ability to restore joint mobility during rehabilitation.

Comparison of mini-plate versus Kirschner wire internal fixation for fifth metacarpal basal fractures with carpometacarpal joint dislocation.

To compare the outcome of mini-plate versus Kirschner wire (K-wire) internal fixation for treating fifth metacarpal basal fractures with carpometacarpal joint dislocation. A total of 46 patients with fifth metacarpal basal fractures combined with carpometacarpal joint dislocation were divided into two groups. The control group received K-wire fixation, while the observation group underwent mini-plate fixation. We assessed treatment effectiveness, surgical parameters, range of motion, serum stress markers, quality of life scores, and postoperative complication rates. A multivariable logistic regression analysis was performed to identify factors influencing postoperative joint function. The observation group demonstrated a significantly higher excellent and good rate compared to the control group (P<0.05). Additionally, the observation group had a lower intraoperative bleeding volume, shorter incision lengths, and faster fracture healing times, all significant differences (all P<0.05). Postoperative assessments indicated that range of motion, quality of life scores, and superoxide dismutase levels were significantly improved in the observation group (P<0.05). Conversely, cortisol, angiotensin II, and norepinephrine levels, along with the incidence of postoperative complications, were lower in the observation group compared to the control group (all P<0.05). Logistic regression analysis identified the surgical method as an independent factor affecting postoperative metacarpal joint function (OR = 0.16, P = 0.003). Mini-plate internal fixation is superior to K-wire fixation for the treatment of fifth metacarpal basal fractures with carpometacarpal joint dislocation. It promotes faster fracture healing, reduces serum stress markers, enhances joint mobility and quality of life, and decreases postoperative complications.

Study of Prevalence, Clinical Pattern and Management of Maxillo-Facial Fractures in a Tertiary Care Centre

Introduction: Maxillofacial injuries are one of the most common injuries prevailing in society because of the strong reliance on road transportation. Road traffic accidents being the most common cause, affecting more than 20 million people worldwide. Multiple modality treatment is often required for the management of maxillofacial fractures, including clinical examination, radio-diagnosis and surgical intervention. 3-D CT face has helped in the reconstruction and reformation of fractures with some limitations to the same. Surgical management still holds a good approach towards the definitive management of maxillofacial fractures. Material and methods: Prospective observational study from 1st February 2021 to 31st July 2022. The parameters used were age, sex, time of incident, etiology, type of vehicle used with preventive measures, type of fractures, and treatment received. All patients underwent proper history taking, clinical examination, radiographic evaluation, and 3-D CT face reconstruction. Results: About 104 patients of maxillo-facial fractures presented to the emergency room of SRMS-IMS, Bareilly, out of which 63 patients were treated with surgical management Conclusion: The study concluded that RTAs were the major cause of maxillofacial trauma with the mandible being the most common bone fracture. ORIF with mini-plate fixation as treatment. lack of helmet and seat belt use, alcohol abuse, over-speeding and failure to follow traffic rules and regulations were the contributing factors

Assessment of biomechanical properties of the new two-hole miniplate internal fixation for bony mallet finger treatment by finite element analysis

Surgery is highly recommended for a bony mallet finger when the fracture fragment involves greater than one-third of the articular surface. K-wire based and plated-based internal fixation are widely used for mallet fracture. However, the outcomes of different surgical treatment options make the treatment of the bony mallet finger controversial due to frequent complications. The two-hole miniplate is a new and promising plate-based internal fixation treatment for the bony mallet finger with low complication rates in recent years. The aim of this study was to evaluate the biomechanical parameters (von Mises stress, strain and deformation) of the two-hole miniplate fixation compared to the traditional K-wire-based fixation using finite element analysis (FEA). Further, the biomechanical parameters of each part of the two-hole miniplate internal fixation were also analyzed. The results indicated that the two-hole miniplate model had the minimum von Mises stress value and the displacement of fracture fragment was less than 30 µm. The two-hole miniplate had an apparent compression effect on the avulsion fracture and inhibited the fracture displacement. This study would provide further guidance for clinical application in using the two-hole miniplate internal fixation.

Skeletal stability after mandible bilateral sagittal split osteotomy – comparison of patient-specific implant and mini-plate fixation: A retrospective study

The aim of the study was to compare the stability of the virtual surgical planning (VSP) and computer-aided design accompanied by patient-specific implants (PSIs) and conventional mini-plates in mandible advancement with bilateral sagittal split osteotomy (BSSO).This retrospective study evaluates the clinical and cephalometric records of 53 patients (12 male, 41 female) treated with BSSO in Helsinki University Hospital. Subjects were divided into two groups: VSP–PSI (21 patients: 4 male and 17 female; mean age 38 years, range 25–53 years); and conventional wafer-based repositioning with mini-plate fixation (32 patients: 8 male and 24 female; mean age 39 years, range 21–56 years). The effect of the amount and direction of the advancement on the stability was also analysed individually. The standardized lateral cephalometric radiographs in three time points were analysed to compare the groups.After surgery (T2), there were no differences between groups in cephalometric variables. During follow-up (T2–T3), the cephalometric variables in both Groups A and B were stable, so there was no difference in stability between the VSP–PSI and the conventional mini-plate groups. During follow-up, the mandibles rotated clockwise or counterclockwise, relapsed towards their original direction, and the changes were statistically significant (jaw relationship; p = 0.018, soft tissue profile; p = 0.025); when the advancement of mandible was >6 mm, the increase in gonial angle compared to mandibles advanced ≤6 mm was statistically significant (p = 0.03).VSP–PSI and conventional mini-plate fixation can be considered equally stable. Large advancements with counterclockwise rotation regardless of fixation method are more susceptible to relapse. VSP-PSI alone cannot solve the relapse-related concerns in mandible osteotomy.

Six Sigma Analysis of Mini-Plate Fixation Systems Used in Human Mandible Fractures: A Clinical Case Study of Symphysis Fracture

The objective of Six Sigma Analysis (SSA) is to determine the robustness level of a current design, process or system considering the expected range of an input parameter. This strategy has been successfully applied to several fields, including healthcare management. This work presents a novel study of SSA to assess the mini-plate fixation employed for mandible fracture. The objective is to reflect the number of concerns in a surgical operation case by performing a statistical measurement of operation capability. A three-dimensional finite element model of a clinical case is elaborated. Some muscles may be severed or damaged during surgery and unable to function to their full potential. To obtain reliable designs, these muscle forces are considered as random variables. The Six Sigma analysis is used to determine if the output parameters satisfy the Six Sigma quality criteria or not. The remarked potential failure modes in this study are found to be similar to those found in a previous reliability study that was applied to the same clinical case. According to the results of SSA, the assessment level (2.462 &lt;&lt; 6) means that much of the data are outside of the demand, and require several improvements to ensure patient satisfaction.

Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial)

BackgroundMandibular angle is the most common site for fractures, accounting for 23–42% of all cases of mandibular fractures. A customized fixation system is designed directly for a specific patient, which reduces the time spent bending and fixing the plate during the operation. This study was designed to assess the effect of CAD/CAM customized V pattern plate versus standard miniplates fixation in mandibular angle fracture.Materials and MethodsThis prospective randomized clinical trial included 26 patients suffering from mandibular angle fracture. Patients were selected from Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University and Ahmed Maher Teaching Hospital. Study group (13) needed open reduction and internal fixation by using CAD/CAM V plate with surgical guide, while control group (13) needed open reduction and internal fixation by using standard superior–inferior miniplate fixation. The patients were then followed up for one year postoperatively.ResultsIt showed that there was a statistical difference between the study group and the control group regarding postoperative pain, occlusion, and maximal interincisal opening (p value < 0.05%). There was no statistical difference (p value > 0.05%) in the postoperative panoramic radiograph that was taken within the postoperative 1st week in both groups, while the increase in mean bone density was statistically significant (p value < 0.05%) from 6 months to one year postoperatively.ConclusionCAD/CAM customized V pattern plate is a suitable plate design because it offers sufficient stability for normal bone healing, the creation of an ideal occlusion, an early return to function, and adequate postoperative radiographic outcomes.Trial RegistrationIt was registered at ClinicalTrials.gov. Registration number: NCT03761524. Registration date: 03.12.2018.

Clinical Outcomes of Minimally Invasive Fixation with Pre-Bent Elastic Stable Intramedullary Nails for the Treatment of Distal Radius Metaphyseal Diaphysis Junction Fractures in Children.

Although mini-plate fixation is an attractive treatment option for distal radius metaphyseal diaphysis junction (DRMDJ) fractures in children, the benefits of minimally invasive fixation (MIF) with pre-bent elastic stable intramedullary nails (MIF) remain underexplored. Therefore, this study aimed to evaluate the clinical efficacy of MIF administration in children with DRMDJ fractures. This retrospective study enrolled 40 patients with DRMDJ fractures who underwent MIF or mini-plate fixation from January 2016 to January 2021. Radiographic parameters, such as palmar inclination and ulnar deflection angle, were examined postoperatively to assess the anatomical reduction of the wrist joint. Clinical outcomes, including the range of wrist flexion and back extension, were examined to analyze the recovery of the wrist range of motion. Additionally, the Gartland-Werley scoring system was used to assess the recovery status of wrist function and healing condition. The student t-test and χ2 test were used to compare differences among groups. All included patients successfully underwent the operation and were followed up for 12-24 months. Patients in the MIF group had a smaller surgical incision length (0.49 ± 0.06 cm) compared to those in the mini-plate fixation group (4.41 ± 0.73 cm) (t = 22.438, p = 0.000). Palmar inclination and ulnar deflection were within the normal range in patients of both groups, and the fractures were successfully anatomically reduced. Moreover, wrist flexion and back extension in the MIF group and mini-plate group were (72.50° ± 0.64° vs. 70.18° ± 0.56°) and (59.55° ± 1.75° vs. 60.04° ± 1.37°), and differences were statistically significant (t = 2.708, p = 0.010 and t = 0.885, p = 0.382, respectively). Furthermore, MIF treatment resulted in a higher proportion of excellent Gartland-Werley scores (94.44%) than mini-plate fixation (86.36%) (p = 0.390). In addition, one case in the mini-plate fixation group experienced re-fracture following the removal of the internal fixation, and the fracture healed after reduction and cast fixation. All patients achieved satisfactory bone healing without other complications. Compared with mini-plate fixation, MIF has the advantages of small incision length, superior range of motion of thr wrist joint, and better maintenance of the physiological radian, providing a promising approach for clinical and surgical treatment of DRMDJ fractures.

Evaluation of osteosynthesis of miniplate versus lag screw in management of mandibular angle fracture - A comparative study

The aim of the study was to compare lag screw and standard (Champy’s) miniplate fixation in the management of mandibular angle fractures and to analyze advantages and disadvantages of one over the other. A total of 30 patients involving mandibular angle fracture reporting to the Department of Oral, Maxillofacial and Reconstructive Surgery, Bapuji Dental College and Hospital, Davangere, were included in the study. Patients were divided into two groups randomly. The procedure was carried out under general anesthesia. Following strict aseptic precautions, an appropriate intraoral/extra-oral incision was selected; fracture site identified, reduced, and after obtaining satisfactory occlusion, temporary maxillo-mandibular fixation was placed using either Erich’s arch bar or Ivy loop eyelet wiring. Fixation was done using either standard miniplate (Group 1) or lag screw (Group 2). The patients were followed up for a period of 2 months at the interval of 1 week, 2 weeks, 4 weeks, and 8 weeks by a blinded experienced oral surgeon for infection, segmental mobility, postoperative occlusion and radiological evaluation of reduction and fixation. Duration of fixation was found to be less in lag screw group than in miniplate group. Radiological evaluation of reduction and fixation was significant in both the groups. No significant difference was found between both the groups in clinical parameters such as infection, segmental mobility and postoperative occlusion. The clinical outcomes of both the lag screw system and standard miniplate systems in the present study were similar. However, the following advantages with the use of lag screw can be highlighted: Relatively lesser fixation time, Superior fracture fragment stability, fewer complications, Stable occlusion &amp; less hardware, less cost required.

Three-dimensional customized titanium plate versus conventional titanium miniplate for management of mandibular angle fractures

Background Surgical treatment of mandibular angle fractures using an internal fixation has changed in the last decades to achieve the required rigidity, stability, and immediate restoration of function. Purpose The aim of the study was to evaluate both clinically and radiologically the efficacy of three-dimensional customized titanium plate versus conventional titanium miniplate in the management of mandibular angle fractures. Patients and methods Sixteen adult patients with unilateral mandibular angle fracture indicated for reduction and internal fixation were selected from the Outpatient Clinic, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tanta University. Patients were divided into two equal groups according to the type of plating system used in fracture fixation, for group I mandibular angle fractures were fixed with 3-D customized titanium plate while for group II mandibular angle fractures were fixed with single conventional titanium miniplate. Postoperative clinical and radiographic evaluations were performed immediately, one week, two weeks, one month, three months and six months. The postoperative clinical evaluation included presence or absence of infection, position and stability of the mandibular lower border, state of occlusion, maximal mouth opening, sensory nerve function, condition of teeth related to the fracture line and patient's tolerance to the plate. The postoperative radiographic examinations evaluated the accuracy of reduction and bony union by measuring the inter-fragmentary gap and the intergonial distance. Results Uneventful wound healing was obtained in all cases of both groups except case no 4 of group II in which dehiscence and mild infection was happened. Satisfactory occlusion was obtained in all cases of both groups except case no 7 of group II where it had mild occlusal derangement. Other parameters including clinical stability, maximal mouth opening, sensory nerve function, and plate tolerance were comparable in both groups. There were no significant differences between group I and group II regarding inter-fragmentary gap and intergonial distance regarding postoperative radiographs. Conclusion The use of three-dimensional customized titanium plate and conventional titanium miniplate fixation systems provided enough stability for proper bone healing, establishment of optimal occlusion, and early return to normal function.