Miniplate Fixation Research Articles

Comparison of Miniplate and K-wire in the Treatment of Metacarpal and Phalangeal Fractures.

IntroductionMetacarpal and phalangeal fractures are common upper limb fractures due to direct blows, axial loading, and torsional loading injuries. The universal goal in treating all fractures for the patient to achieve normal motion, but the ideal technique for stabilization is still debated. For internal fixation, Kirschner wires (K-wires) or miniplates can be used, and each carries certain advantages. No previous study has compared K-wire use to miniplate use in treating metacarpal and phalangeal fractures. Therefore, we conducted this randomized control trial to evaluate the outcomes of K-wire and miniplate use in treating metacarpal and phalangeal fractures.Materials and methodsThis randomized controlled trial was conducted in the Department of Orthopaedic Surgery, Bahawal Victoria Hospital, from February 2017 to February 2018. Seventy-five patients were included in this study and randomly assigned into two groups. One group was treated with K-wire fixation, and the other group was treated with miniplate fixation. We assessed total active motion (TAM), range of motion (ROM), duration of injury, and complication rate. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Armonk, NY: IBM Corp). P values ≤ 0.05 were considered significant.ResultsMean surgical time, pain scale, and time of union of K-wire treated patients was 38.63±3.64 minutes, 4.17±1.11, and 12.95±3.38 weeks, respectively. The success of the union was noted in 38 K-wire patients (95%). Total active ROM was greater in miniplate fixation patients compared with K-wire treated patients, but this difference was statistically significant. Similarly, TAM was also greater in the miniplate fixation patients compared to the K-wire treated patients, but this difference was also not statistically significant.ConclusionBoth K-wire fixation and miniplate fixation are equally effective in terms of TAM, ROM, and complications when used to treat metacarpal and phalangeal fractures.

Management of unstable metacarpal shaft fractures by k-wires versus mini-plate fixation

Objective To compare the clinical and functional outcome of treatment of unstable metacarpal shaft fracture by K-wires versus open reduction and mini-plate fixation prospectively. Place and duration The study was conducted at the Department of Orthopedic, Al-Zahraa Hospital, Faculty of Medicine for Girls, Al Azhar University, for a duration of 1 year from 1st January 2019 to 30th December 2019. Patients and methods A total of 20 patients with unstable metacarpal shaft fracture were divided into two groups. Group A included 10 patients who were fixed by mini-plate and screws. Group B included 10 patients who were fixed by K-wires. Hand function was assessed 3 months postoperatively and when the patients finish physiotherapy by using Quick DASH score. Results Union occurred in all cases. In group A, only one (5%) case reported tendon adherence. In group B, three (15%) cases reported joint stiffness. Conclusion The mini-plate fixation is superior to K-wire fixation in the treatment of unstable metacarpal shaft fractures.

Comperative evaluation of the current and new design miniplate fixation techniques of the advanced sagittal split ramus osteotomy using three-dimensional finite element analysis.

The aim of this study was to evaluate the stress occurring in the fixation systems both developed in various geometric designs for this study and currently used in sagittal split ramus advancement osteotomy using finite element analysis. The finite element model that imitates three-dimensional sagittal split advancement osteotomy was fixed in 10 different miniplate fixation methods: one miniplate fixed with four monocortical screws in a horizontal and oblique pattern; four-hole two miniplates with eight monocortical screws; five-hole miniplate fixed with four monocortical and one bicortical screws; six-hole straight and curved miniplates fixed with six monocortical screws in different geometric designs. Unilateral masticatory muscle loads that have previously determined in the literature were applied to the model at the anatomical muscle attachment regions and the data obtained from finite element analysis and static linear analysis methods were recorded as Von mises, maximum principle and minimum principle stress values. It was observed from the results that maximum stress occurred in Group 1, which consisted of double backward T-shaped miniplate with 6-holes and, minimum stress occured in group 10, which mimiced hybrid system with one miniplate and four monocortical and one bicortical screws. Based on our results, the stress on the miniplates changes according to the geometric designs and the stress on the miniplate decreases as the numbers of miniplates and bars increase. The hybrid miniplate may be preferred by the surgeon as it will be exposed to less stress in excessive mandibular advancements by using the advantages of both the miniplate and the bicortical screw.

Double J Fixation after Craniotomy: Technical Description of a Modification Method for Bone Flap Fixation (Hiederov Method)

Background: Fixation of bone flap following craniotomy is usually achieved by synthetic materials. In rural and poor funding areas, innovation for cheap, safe and applicable material is needed. Purpose: The aim is to assess our new innovative technique in bone flap fixation against traditional techniques. Patients and Methods: The study was a prospective randomized controlled study enrolled at Al-Amal Hospital and Al-Ahly Bank Hospital from 2014-2019. Forty-eight patients were randomized in the study. Group A (24 patients) underwent titanium miniplate fixation while group B (24 patients) underwent our new technique. The new technique is double J tunnels performed by craniotome on either side of the bone (flap and skull sides), then a Prolene suture is passed through the shared stem of J’ holes and secured in the wrapped side of J’s holes and tying it tightly. Both techniques were examined against fixation time, rigidity, offset and final judgment postoperatively. Result: There was no statistically significant difference in using both techniques as regard fixation time. Our new technique was not inferior to the traditional one in achieving rigidity (p > 0.05). The final postoperative assessment was as equal as that seen in miniplate fixation. Conclusion: This technique is a simple, easy, cheap and effective method of fixing craniotomy bone flap.

Is Ideal Treatment of Metacarpal and Phalangeal Fractures Possible? Clinical and Radiological Outcomes of Three Surgical Choices

Objectives: We purposed to determine which of the surgical treatment options for metacarpal and phalangeal fractures, a subject that has limited coverage in the literature, is best. Methods: Sixty-three patients who were surgically treated for closed and extra-articular metacarpal (41.9%) and phalangeal (58.1%) fractures were included in a randomized prospective clinical trial between August 2015 and August 2017. The patients were divided into three groups using block randomization: open reduction and internal fixation (ORIF) with miniplate plus screw fixation (MP Group; 6F/15M), ORIF with screw only fixation (SO Group; 5F/16M), and closed reduction and percutaneous K-wire fixation (KW Group; 3F/18M). The patients were followed up at 10 days and 3 weeks for wound care, at 3 months, and at the end of the first year and assessed based on dynamometer measurement, Q-DASH, and range of motion (ROM). Results: Time to return to work was 77.56 ± 33.85 days, while Q-DASH scores at 3 months and 1 year and dynamometer values at 3 months were significantly higher in KW Group (p

Minimal access fixation of mandibular angle fracture.

Angle fractures represent the highest percentage of mandibular fractures. Fixation using a single miniplate ventral to oblique line of buccal cortex of the mandible was described by Champy et al. (1976). Ellis has documented low complication rate with monocortical miniplate fixation as a treatment for angle fractures. Most often used approaches are (a) extraoral approach, (b) intraoral approach, and (c) transbuccal approach. Each of these techniques has its pros and cons. We, in this note, propose an approach which sidelines the drawbacks of these approaches and has the combined advantages of these techniques. This technique results in no external scarring or injury to marginal mandibular nerve, and it also allows direct visualization and confirmation of occlusion during plate placement. This approach is through a contaminated area that poses a risk of infection. This approach of ours is based upon this pioneering works of Forrest. The approach proposed by us can aid an experienced maxillofacial surgeon to provide economical outpatient-based care to patients with minimally displaced/undisplaced angle fracture in a routine dental setup. This technique can be breakthrough for introduction of endoscopic approach for treating angle fracture.

Radiological Imaging Analysis of Cervical Expansive Open-door Laminoplasty Causing C5 Palsy

The aim of this research is to explore the difference of imaging parameters in patients with C5 palsy after cervical expansive open-door laminoplasty. A retrospective analysis was made on the clinical data of 62 patients who were diagnosed as multiple cervical spondylotic myelopathy and operated with cervical expansive open-door laminoplasty using Centerpiece titanium miniplate fixation. According to weather C5 nerve root palsy occurred after surgery, the patients were divided into normal group (group A with 8 cases) and paralysis group (group B with 54 cases). The preoperative and postoperative cervical spine angle (C2–7) enlargement rate of spinal canal, distance of spine cord shifting and cervical curvature between two groups were measured. Compare with group A (27.38±1.99°), the average lamina open angle of group B (34.56±5.55°) was larger, which were found statistically significant difference (P<0.05). In addition, there were no significant differences between two groups in C3 or C7 lamina open angle. However, significant differences were found between two groups in C4, C5 and C6 lamina open angle. The average enlargement rate of spinal canal and distance of spine cord shifting of group B were larger than group A, which was statistically differences (P<0.05). The opening angle of the lamina, the expansion rate of the spinal canal, and the distance of the spinal cord may prevent the occurrence of cervical 5 nerve root palsy in cervical expansive open-door laminoplasty.

A significant effect of bone anisotropy on reliability measurements of mini-plate fixation system used in multiple mandibular fractures: A clinical case of angular and parasymphysis fractures

A significant effect of bone anisotropy on reliability measurements of mini-plate fixation system used in multiple mandibular fractures: A clinical case of angular and parasymphysis fractures

A prospective study of functional outcome between Mini-plates and percutaneous K-wire fixation following metacarpal shaft fractures

Background: Metacarpal fractures comprise between 18–44 % of all hand fractures. Too often these metacarpal fractures are neglected or treated as minor injuries and results in major disability and deformity with permanent crippling of fine movements. A stable fracture fixation helps in restoring early mobilization. Early mobilization can prevent adhesions and is the key to good clinical outcome. Methods: Thirty six patients with metacarpal fractures were surgically fixed with k-wire or plate and screw in our trauma centre. 27 males and 9 females patients were part of the study. Radiographs of affected hand, both AP & Lateral views were obtained before surgery, post- surgery, and at follow-ups. Results: In this study, after 6 weeks of follow up it was found that metacarpal shaft fractures fixed with ORIF with mini plates show better functional outcome compared to CRIF with percutaneous K-wires. Finger stiffness being the commonly encountered complication. Conclusions: Mini-plates fixation in oblique and spiral fractures provide stable and rigid internal fixation that allows early active range of motion and early excellent results. Percutaneous K-wire fixation has the advantages of preserving the soft tissue.

Miniplate removal in operated cases of maxillofacial region in a dental institute in Rajasthan, India.

BackgroundThe long term management of miniplate fixation osteosynthesis remains debatable and controversial with few authors advocating routine removal of the miniplates after 3–6 months of placement, while others recommend retention of the miniplates unless their removal is clinically indicated.ObjectiveThe aim was to study the incidence, indications, time gap, role of metallic composition and site of removal of miniplates in operated cases of maxillofacial region over a two-year period.MethodsPatients undergoing removal of miniplates over 2-year period were studied and evaluated regarding the number of miniplates removed, time gap present between fixation and removal of miniplates, indications for removal, metallic composition of miniplates removed, sites of removal and complications. Correlations between indications for miniplate removal based upon time gap, metallic composition, age group and number of miniplates present were determined using Chi-square test. Correlation between metallic composition of miniplate and time gap was also determined using Chi-square test.ResultsThe miniplates were removed in 20 patients (16 males and 4 females). Most common indication for removal was infection (45%). Forty-five percent of the patients underwent miniplate removal within 1 year of placement. Thirty-four miniplates and 118 screws were removed. The correlation between indications for miniplate removal and time gap was found to be statistically significant (P = 0.04).ConclusionMost of the hardware removal is performed subsequent to complications associated with hardware and local factors play more important role than metallic composition. Routine asymptomatic miniplates do not require removal and is not recommended.

Failure Analysis of the Superior Lateral Plate Technique for Mandibular Angle Fractures

The mandibular angle is often found to be the second most common site of mandible fractures following condylar fractures and consists of up to 25% of all mandible fractures, according to Fonseca. Mandibular angle fractures are also known to be the most common site for postoperative complications as with a complication rate reported of up to 30%. Our institution has been treating angle fractures with open reduction and single plate fixation at the superior lateral border utilizing a trans-buccal approach. Other fixation options include a superior border miniplate (Champy technique), 2 miniplate fixation and inferior border fracture or reconstructive plate via a transfacial approach. Previous studies (Ellis) have shown the superior lateral technique was found to be favorable. This study aims to examine current data and review the variables that may contribute to the observed complications in mandibular angle fractures.

Comparison of postoperative paresthesia after sagittal split osteotomy among different fixation methods: a one year follow-up study.

ObjectivesPostoperative paresthesia is a common complication after sagittal split osteotomy (SSO). This study aimed to compare paresthesia among different fixation methods one year postoperative.Materials and MethodsThis prospective cohort study assessed subjects in four groups: class II with miniplate fixation (Group 1), class II with three-screw fixation (Group 2), class III with miniplate fixation (Group 3), and class III with three-screw fixation (Group 4). Paresthesia was evaluated one year postoperative based on a 0-10 visual analogue scale. Pearson correlation was used to evaluate associations of age and mandibular movement with paresthesia. ANOVA was used to compare paresthesia among groups.ResultsA total of 80 subjects were enrolled, with 20 subjects in each of the four groups. The Pearson correlation test demonstrated a significant correlation between mandibular movement and paresthesia (P=0.001). Comparison of paresthesia among the groups showed significant differences among groups 1 and 2, 2 and 3, and 3 and 4 (P<0.05).ConclusionThe three-screw fixation method led to more paresthesia one year postoperative compared with miniplate fixation. In addition, the magnitude of mandibular movement had a positive correlation with paresthesia.

Evaluation of labial versus labio-inferior lines of osteosynthesis using 3D miniplate for fractures of anterior mandible: A finite element analysis with a pilot clinical trial

PurposeThe fractures of anterior mandible are subject to severe torsional forces due to muscles acting in opposite directions. 3D miniplate has been suggested as a good alternative by some researchers. However, finite element model (FEM) studies indicate that labio-inferior positioning of two miniplates perpendicular to each other offers better stability as compared to labial positioning. This study aims at combining the advantages of a single 3D miniplate and labio-inferior positioning of two conventional miniplates, which was assessed by finite element analysis along with a pilot clinical trial. MethodsTwo FEM models were created using CT data of a 24-year-old patient with Angle class I occlusion: control model with labial plating and study model with labio-inferior plating. The models were processed with MIMICS® (materialise, Leuven, Belgium), CATIA® (Dassault Systemes) and finite element analysis softwares. Parameters adopted for analysis were (1) displacement (mm) of fracture fragments during each screw fixation, (2) lingual splay and post fixation stability of fracture fragments with masticatory load, and (3) stress distribution (MPa) across fracture fragments. Moreover, a pilot clinical trial including five patients with anterior mandible fracture was conducted. The fractures were managed by intraoral open reduction and 3D miniplate fixation in labio-inferior position. Intraoperative interfragmentary gap, post fixation lingual splay and radiographic fracture union and complications were assessed clinically. ResultsLabio-inferior plating demonstrated less displacement (mm) of fracture fragments during screw fixation (0.059 vs. 0.079) as well as after application of masticatory load (1.805 vs. 1.860). Negligible lingual splay and less stress distribution (MPa) across fracture fragments (1.860 vs. 1.847) were appreciated in the study group as compared to control group. Clinical trial support the favorable outcome related to intraoperative and postoperative assessment parameters. ConclusionFEM analysis and clinical trial reveal better results with labio-inferior positioning of 3D miniplate when compared to labial positioning.

Efficacy of different fixation techniques in repair of anterior mandibular fractures

Objective: To compare between double straight miniplates, double inverted L- shaped miniplates ,and three dimensional ( 3 D) rectangular miniplate in fixation of anterior mandibular (symphyseal / parasymphyseal area) fractures .Patients and methods: Thirty adult patients with anterior mandibular fractures were included in this study. The patients were divided randomly into three equal groups, group I was treated by superior and inferior straight miniplate while group II was treated by double L- shaped miniplates fixation technique and group III was treated by 3D rectangular miniplate. Postoperative clinical, radiographic evaluation and quantitative measurements were performed.Results: Wound healing was optimal in all cases except two cases in group I and one case in group II. Satisfactory occlusion was obtained in all cases except three cases in group I where it had mild to moderate occlusal derangement. Other parameters including maximal mouth opening, sensory nerve function, and patient's tolerance to the plate were comparable. There were the similarity between the density changes for the three groups as there was highly significant difference in G(I) compared to G(II) at six months, and G(I) compared to G(III) at three and six months also between G (II) compared to G(III) at six months. .Conclusion: Both double L-shaped miniplates and 3D rectangular miniplate provided enough stability for proper bone healing, establishment of optimal occlusion and early return to normal function more than with double straight miniplates. Additionally, there is superiority of 3 D rectangular miniplate over double inverted L- shaped miniplates in these parameters.

Paper #5 - Biomechanical analysis of plate fixation in the Latarjet procedure

Background: The Latarjet procedure has become the treatment of choice for the management of patients with anterior glenohumeral instability with clinically significant anterior glenoid bone loss. Multiple techniques for coracoid fixation have been described, all of which utilize a variety of screw constructs with varying screw sizes. Recently, the use of a mini-plate has been reported, with encouraging radiographic outcomes. The purpose of this study was to determine the biomechanical properties of mini-plate fixation for the Latarjet procedure, and to compare these findings to various screw fixation configurations.

Miniplate Augmented Tension-Band Wiring for Comminuted Patella Fractures.

The aim of this study was to introduce various applications of miniplate augmented tension-band wiring (TBW) for comminuted patella fractures and to evaluate the clinical outcomes. Comminuted articular patella fractures were managed with anterior cortical miniplate fixation with a TBW technique from January 2014 to January 2016. The primary end point was radiographic union. Secondary end points were complications related to the procedure. Functional outcomes including range of motion were also evaluated. Thirty patients were followed up for a mean of 20 months (range, 12-28) postoperatively. The primary union rate was 96% (29 of 30 patients). Mean time to union was 3.2 months. One patient required additional surgery because of acute postoperative infection. Twenty-five patients recovered a full range of motion relative to the contralateral limb. The mean Bostman score at the last follow-up was 28.6 points (range, 26-30). In conclusion, miniplate augmented TBW is a versatile and useful technique for comminuted patella fracture fixation.

Comparative study on long-term stability in mandibular sagittal split ramus osteotomy: hydroxyapatite/poly-l-lactide mesh versus titanium miniplate

BackgroundResorbable devices have recently been adopted in the field of orthognathic surgery with controversies about their postoperative skeletal stability. Hence, we determined the long-term skeletal stability of unsintered hydroxyapatite/poly-l-lactic acid (HA/PLLA) mesh for osteofixation of mandibular sagittal split ramus osteotomy (SSRO), and compared it with that of titanium miniplate.MethodsPatients were divided into resorbable mesh and titanium miniplate fixation groups. A comparative study of the change in the mandibular position was performed with preoperative, 1-day, 6-month, and 2-year postoperative lateral cephalograms.ResultsAt postoperative 6 months—compared with postoperative 1 day, point B (supra-mentale) was significantly displaced anteriorly in the titanium-fixation group. Moreover, at postoperative 2 years—compared with postoperative 6 months, point B was significantly displaced inferiorly in the titanium-fixation. However, the HA/PLLA mesh-fixation group did not show any significant change with respect to point B postoperatively.ConclusionsThe HA/PLLA mesh-fixation group demonstrated superior long-term skeletal stability with respect to the position of mandible, when compared with the titanium-fixation group.

Management of mandibular angle fractures using 3- dimensional or standard miniplates: A systematic review and meta-analysis

PurposeThis study proposed to compare clinical outcomes between three-dimensional (3D) plate and standard miniplate fixation systems for the management of mandibular angle fractures (MAFs). MethodsA systematic review search of several databases, including MEDLINE-Ovid, Embase, Springer Link, and PubMed, for relevant articles in English and without date restrictions was performed in February 2018. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure postoperative complications. ResultsEleven publications were enrolled in the analysis. The results showed that there were significant differences in overall complications (RR, 0.453; 95% CI, 0.311–0.660; P = 0.007). The incidence of hardware failure showed a statistically significant difference in the outcome, favoring 3D miniplates (fixed: RR 0.156; 95% CI, 0.042–0.581; P = 0.0006). Subgroup analyses indicated that the 3D miniplate caused a lower incidence rate of malunion and hardware failure than the standard miniplate with 8 or 10 holes (P = 0.006, P = 0.03, respectively). In addition, the use of standard miniplates had a shorter operation time than the use of 3D miniplates (P = 0.002). ConclusionThe present study demonstrates that the three-dimensional miniplate was a better fixation system than the standard miniplate technique in reducing postoperative complications in the management of mandibular angle fracture (P = 0.007).

Influence of bone anisotropy on reliability assessment of mini-plate fixation system stabilization in symphysis mandibular fractures: Two studied cases under convalescence period

The reliability analysis is used to in order to measure the stability of the mini-plate fixation system used in the human fractured mandibles after the chirurgical operation. The failure is assumed to take place when the Most Probable failure Point (MPP) is found. In this work, two studied cases of 3-dimensional finite element models are considered for the same fracture situation. A successful fracture healing requires that a number of constraints which are influenced by the loading conditions are fulfilled, and since muscle activity is difficult to evaluate, there is a strong need to introduce loading uncertainties in order to obtain a reliable design. Several categories of critical failure scenarios are considered in this study: The first category of failure scenarios is that of the relative displacement between two fracture surfaces should not exceed a critical threshold to ensure rapid healing. The second category is failure of the mini-plates which in this work is interpreted as when the yield stress within the mini-plates is reached, and the third category of failure scenarios is that of the yield stress in the mandible bone tissues should not be exceeded. Two fractured mandibles are studied under the convalescence period: Case I (a single isotropic bone tissue) and Case II (composite anisotropic bone tissues). During the fixation of the mini-plates, the drilling positions in the two cases can vary when considering a composite bone tissue mandible relative to a homogeneous bone tissue one. To show the effect of the bone anisotropy, an analytical formulation is developed as a helpful technique to analyze the effect of the mini-plate position changes. The bone properties used in the anisotropic case (Case II) are orthotropic. The results show that the reliability indices are very affected when considering the bone anisotropy.

Comparison of Post-Operative Outcomes of Intermaxillary Fixation and Open Reduction with Internal Fixation of Simple Mandibular Angle Fracture: A Randomized Control Trial

Background: Surgical management of simple mandibular angle fracture is a very crucial process.Objective: The purpose of the present study was to compare the post-operative outcomes of intermaxillary fixation and open reduction with internal fixation of simple mandibular angle fracture.Methodology: This randomized control trial was conducted in the Department of Oral and Maxillofacial Surgery at Dhaka Dental College &amp; Hospital, Dhaka and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to December 2010 for a period of one (01) year. Among all patients admitted/attended to the hospital IPD with fracture of mandibular angle with or without other associated fracture sites were selected as study subjects. After recruitment of the patients, they were assigned either as group A or group B after randomization. In group A the patients of this group were treated by open reduction and internal miniplate fixation with additional placement of intermaxillary fixation; in group B the patients of this group were treated by open reduction and internal miniplate fixation without any additional placement of intermaxillary fixation. During follow up period stability of fracture segments, post reduction alignment and inter-incisal opening were recorded.Result: A total of 30 patients presented with mandibular angle fractures were included in the study. They were allocated in two groups named miniplate osteosynthesis with Inter-maxillary fixation group (n=16) and without inter-maxillary fixation group (n=14) randomly. Time required to accomplish the surgical procedures was significantly high (p=0.000) group A (99.38±15.26 minutes) than group B (55.38±6.34 minutes). Among them 01 patient developed instability after inter-maxillary fixation. And 01 patient developed such in other procedure; however this difference is not statistically significant (p=0.724). In post operative radiography the mean score of post reduction alignment was slightly higher in group A than group B which was 2.50±0.516 and 2.214±0.426 respectively (p=0.107). The inter-incisal opening in baseline was 14.69 and 18.14 in group A and group B respectively. However, in review 3 it was found 36.19 and 37.64 in group A and group B respectively (p=0.0001).Conclusion: In conclusion significantly less operative time was required to accomplish the operative procedure in without IMF group as well as there was also a significant difference of inter-incisal opening between two procedures in subsequent review findingsJournal of National Institute of Neurosciences Bangladesh, 2018;4(2): 108-112