Miniplate Osteosynthesis Research Articles

An unusual case of atrophic mandible fracture in a patient with osteogenesis imperfecta and on oral bisphosphonate therapy: Case report.

Fractures of severely atrophic (height<10mm) edentulous mandibles are infrequent and challenging to manage. Factors such as sclerotic bone and decreased vascularity combined with systemic diseases complicate the management of such fractures. Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders of type I collagen metabolism. Patients with OI characteristically present with histories of long bone fractures, deformities, blue sclerae, and opalescent dentin. However, fractures of the facial skeleton are rare. Bisphosphonate therapy has been proven to effectively reduce the fracture risk in patients with OI. The purpose of this clinical report is to present an unusual case of spontaneous fracture of the atrophic mandible in a patient with OI. Despite open reduction and internal fixation (ORIF) with miniplate osteosynthesis, the patient developed a second fracture at a screw placement site distal to the first fracture. The patient was successfully treated with ORIF using locking reconstruction plates fixed in the symphyseal and angle regions. Bone healing following ORIF was normal, and no clinical sign of osteonecrosis as a result of bisphosphonate therapy was observed. Patients with OI can present with spontaneous fractures of already weakened mandibles. Although such fractures can be managed with care using established protocols, further research is required to examine the effects of concomitant medication, such as bisphosphonates.

Comparative evaluation of bite forces in patients after treatment of mandibular fractures with miniplate osteosynthesis and internal locking miniplate osteosynthesis.

Aims and Objectives:The aim of present study was to compare the stability of fractured mandibular fragments under functional load, when fixed with conventional miniplate and internal locking miniplate.Materials and Methods:Bite force (in kg) recorded in twenty mandible fractured patients and fifty normal healthy individuals. Bite force was measured at incisor and molar regions. Comparative evaluation of bite force generated was performed between 10 cases treated with conventional miniplates and 10 cases treated with internal locking miniplates. Bite force generated by patients in mandibular fracture between symphysis and the angle of mandible was recorded in incisor and molar regions preoperatively. The fracture fragments were fixed using the above fixation techniques. Then same recording was undertaken on the 7th, 14th, 21st, 28th, and 90th days postoperatively.Results:Bite force generated by patients treated with locking plates at the 7th, 14th, 21st, 28th, and 90th postoperative days was significantly higher as compared to those in patients treated with miniplates.Conclusion:It was observed in our study that the locking plate/screw system offers significant advantages over the conventional plating system. There are no intraoperative difficulties associated with placement of the plate.

Analysis of complication of mandibular fracture

Background: In recent times, the use of wire osteosynthesis with maxillomandibular fixation (MMF) has been replaced by miniplate osteosynthesis. This has been attributed to the complications following the use of the earlier mentioned treatment modality. This however, cannot be said to be the same in developing countries mainly due to inadequate resources. The present study is aimed at identifying the complications associated with the use of wire osteosynthesis and MMF with the aim of determining if despite the said complications, these treatment modalities are still relevant in a resource poor setting. Materials and Methods: A descriptive cross-sectional study of all patients presenting with mandibular fractures to the accident and emergency department and the maxillofacial surgery unit of Aminu Kano Teaching hospital over a 2-year period who consented to participate in the study were recruited. Results: Closed reduction and immobilization was the commonest modality of treatment accounting for 53.10%, while open reduction and internal fixation using wire osteosynthesis accounted for only 34.51%. Majority of the subjects (53.98%) were treated under general anesthesia, while local anesthesia was used in 38.94% of cases. In addition, there was an insignificant association between modalities of treatment and etiology of fracture (χ2 = 18.235; degrees of freedom (df) = 24; P = 0.791, and critical χ2 = 37.65). In terms of complications, about 12.82% of patients who had open reduction as a form of treatment suffered nonunion as against 10% in closed reduction. Malunion, however, was higher in closed reduction (8.33%) than in open reduction which accounted for 5.13%. Not surprisingly, open reduction presented with a high rate of infection of about 28% as against 18.33% in closed reduction. Similarly, closed reduction presented with a higher rate of malocclusion of about 6.67% compared with 5.13% recorded with open reduction. Conclusion: Despite the advent of miniplate osteosynthesis, the relevance of wire osteosynthesis and MMF in a resource poor setting cannot be underestimated.

Effects of postoperative early motion on the results of osteosynthesis with miniplates in metacarpal fractures

Objectives: In our study, we aimed to evaluate the radiological and functional results of rigid internal fixation with mini plate osteosynthesis in the management of metacarpal fractures. Methods: In this study, 11 patients (10 males, 1 female) which were treated with mini plate osteosynthesis for metacarpal fracture (n=13) were evaluated retrospectively. The average age of patients was 35 years (range 25-46 years) with a mean follow-up of 1.4 years (range 1.1 to 2.2-years). Rehabilitation program was started on the postoperative second day. Range of motion was assessed according to the total active range of motion (TAROM) scale. Results: Eight patients (10 metacarpal) had excellent scores, two patients had good scores and one patient had moderate score at final follow-up. Time to union was found an average of 6 weeks (range 4-7 weeks). Complications did not observed such as loss of reduction, infection, circulatory disorders, neurological symptoms, osteonecrosis, sudeck atrophy. Conclusion: Rigid internal fixation with mini plate osteosynthesis could be performed in patients with metacarpal fractures with satisfactory radiological and functional results along with rehabilitation program contains passive and active joint movements initiated at early post-operative period.

Screw-Wire Osteo-Traction: An Adjunctive or Alternative Method of Anatomical Reduction of Multisegment Midfacial Fractures? A Description of Technique and Prospective Study of 40 Patients

Stable anatomical fracture reduction and segment control before miniplate fixation can be difficult to achieve in comminuted midfacial fractures. Fracture mobilization and reduction methods include Gillies elevation, malar hook, and Dingman elevators. No single method is used universally. Disadvantages include imprecise segment alignment and poor segment stability/control. We have employed screw-wire osteo-traction (SWOT) to address this problem. A literature review revealed two published reports. The aims were to evaluate the SWOT technique effectiveness as a fracture reduction method and to examine rates of revision fixation and plate removal. We recruited 40 consecutive patients requiring open reduction and internal fixation of multisegment midfacial fractures (2009-2012) and employed miniplate osteosynthesis in all patients. SWOT was used as a default reduction method in all patients. The rates of successful fracture reduction achieved by SWOT alone or in combination and of revision fixation and plate removal, were used as outcome indices of the reduction method effectiveness. The SWOT technique achieved satisfactory anatomical reduction in 27/40 patients when used alone. Other reduction methods were also used in 13/40 patients. No patient required revision fixation and three patients required late plate removal. SWOT can be used across the midface fracture pattern in conjunction with other methods or as a sole reduction method before miniplate fixation.

Failure of Miniplate Osteosynthesis for the Management of Atrophic Mandibular Fracture

Fractures of the severely atrophic (<10 mm) edentulous mandible are not common, and these fractures with a vertical height of 10 mm or less have long been recognized as being particularly problematic. Although there are advances in the treatment of the atrophic mandibular fracture, the treatment remains controversial. There are some options for treatment planning because of using small miniplates to large reconstruction plates. However, when the fixation method fails, it causes malunion, nonunion, and/or infection, and sometimes it has been associated with large bone defects. The authors describe a clinical report of a failed miniplate fixation for atrophic mandibular fracture management. The authors used a load-bearing reconstruction plate combined with autogenous bone graft from iliac crest for this retreatment. The authors show a follow-up of 6 months, with union of the fracture line and no complication postoperatively.

Presurgical orthopaedics/nasoalveolar moulding in cleft children: could you, should you, would you?

‘Amalgam versus composite’, ‘wisdom tooth coronectomy versus extraction in toto’, ‘wet versus dry bonding’, ‘smooth versus rough implants’, ‘cortical screws versus Mini-plate osteosynthesis’ – there are controversies, myths and mystery in all areas of modern dentistry, even today, in this age of scientific evidence, best practice and big brother. In the cleft world, controversies also abound. In fact, fundamental questions remain unanswered: we still do not know what the best overall treatment protocol is for the child born with a complete unilateral bony cleft lip and palate.1 Little by little, however, the evidence base is enlarging. Centralised UK regional cleft services, knowledge of national and international outcomes, and research protocols all aid the plugging of these gaps in our knowledge, and help us to find the missing pieces of the cleft jigsaw.

Transoral Open Reduction and Fixation of Mandibular Condylar Base and Neck Fractures in Children and Young Teenagers—A Beneficial Treatment Option?

To evaluate the possible benefits of open surgery, endoscopically assisted reduction and fixation using a transoral route was used in a selected series of pediatric patients with displaced condylar base and neck fractures. A cohort of 6 patients (1 male and 5 female; age range, 7 to 15 yr; mean, 13.4 yr) with displaced condylar base and neck fractures (n = 9) were included. Inclusion criteria were age younger than 16 years, fracture of the condylar base or neck, and displacement of the fracture by at least 45°. Fractures were classified using conventional radiography, cone-beam computed tomography, or computed tomography. Patients underwent transoral endoscopically assisted open reduction and fixation using miniplate osteosynthesis. Postoperatively, patients were followed clinically and radiographically for 18 months. Complete follow-up varied from 18 to 35 months (median, 24.5 months). All patients showed normal occlusion and pain-free unrestricted function of the temporomandibular joint at 3, 6, 12, and 18 months postoperatively. There were no signs of incomplete remodeling or deformation of the condyles. Transoral endoscopically assisted surgical treatment of severely displaced condylar base and neck fractures in children and young teenagers offers a reliable solution to preclude the sequelae of closed treatment, such as altered morphology and functional disturbances, eliminates visible scars, and lowers the risk of facial nerve damage compared with open reduction using an extraoral approach.

A Prospective Randomized Clinical Trial Comparing 3D and Standard Miniplates in Treatment of Mandibular Symphysis and Parasymphysis Fractures.

To compare the efficacy of the 3D miniplates to standard miniplates in the osteosynthesis of mandibular symphysis and parasymphysis fractures on the basis of clinical parameters and radiographic evaluation. A prospective randomized clinical trial was conducted to treat consecutive mandibular symphysis and parasymphysis fractures. The patients were randomly divided into 2 groups. The patients underwent osteosynthesis in group A with 3D titanium miniplates and in group B with conventional titanium miniplates. The cause of trauma, the number of days from injury to surgery, average age and gender were all reviewed. The assessment of the patients was done at 1, 3, and 6weeks and 3months using the clinical parameters and radiographic evaluation. Eighty patients with isolated symphysis or parasymphysis fracture met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. Similarly Radiological evaluation did not show any statistically significant difference in reduction between the 2 groups. 3D plates are difficult to adapt and use sometimes, but operative time is less with them in treatment of symphysis and parasymphysis fractures. The use of 3D miniplates for symphysis and parasymphysis fracture fixation was efficacious enough to bear the masticatory load during osteosynthesis of the fracture. Although 3D miniplate system is difficult to adapt and difficult to use in cases of fractures involving the mental nerve, they provide the advantage of less operative time and less implant material in treatment of symphysis and parasymphysis fracture, with clinical results almost similar to those seen with conventional miniplate osteosynthesis.

Matrix miniplate versus locking miniplate in the management of displaced mandibular angle fractures

Aim:The purpose of this study was to determine and compare various postoperative parameters like ease of operability, plate adaptability, stability etc., associated with use of matrix miniplate versus locking miniplate in the treatment of displaced mandibular angle fractures.Materials and Methods:The study was carried out in the Department of Oral and Maxillofacial surgery, King George's Medical College, GM and Associated Hospital, Lucknow. Total 50 patients were treated and included in the study. These were divided into two groups of 25 each and were treated with two of the standard techniques, i.e., one is matrix miniplate osteosynthesis and other is locking miniplate osteosynthesis. These patients were evaluated for postoperative complications and the differences between the two Groups were assessed.Results:Patients treated by matrix miniplate showed better recovery phase postoperatively as compared to locking miniplate group.Conclusion:Based on this study matrix mini plate osteosynthesis may be considered as the better alternative method available for the treatment of displaced mandibular angle fractures.

Treatment modalities in zygomatic complex fractures: A prospective short clinical study

Introduction: Zygomatic complex fractures or the tetrapod fractures are common to occur followed by the nasal bone fractures because of its prominent location. At the same time, it is difficult to obtain perfect reduction and contour postoperatively because of its complex involvement with four bones namely maxillary, temporal, orbital and greater wing of sphenoid bone. Various classifications have been put forward for better understanding and planning of treatment protocol. Aim: This study aims at comparing the following variables after reduction and fixation of fracture zygomatic complex; 1. Esthetics 2. Restoration of anatomical form 3. Occlusion 4. Function 5. Neurological deficits. Materials and Methods: Twenty patients were selected following a clinical and radiographic examination of fracture of the zygomatic complex. Reduction techniques used were Gillie's, Dingman's lateral eyebrow, and upper buccal sulcus approaches. Fixation was done at single-point or two-point or three-point protocol by transosseous wiring or miniplate osteosynthesis. Results: Among the twenty cases treated, all were males. Age distribution of the patients was between 20-60 years with a mean age of 39.5 years. There was facial asymmetry in four cases postoperatively and two among them did not follow postoperative instructions. Conclusions: Closed reduction namely Gillie's temporal approach was found to be the best reduction technique and the protocol of three point, miniplate fixation was effective in terms of stability and relapse.

Genotoxicity of fixation devices analyzed by the frequencies of sister chromatid exchange

Metal alloys utilized in the management of jaw fractures may exert genotoxic effects. Our purpose was to compare the genotoxicity of intermaxillary fixation devices containing nickel and chromium to that of titanium miniplates utilized in treatment of jaw fractures through the analysis of sister chromatid exchange. In this prospective study, in a total of 28 non-smoker patients (10 females, 18 males; mean age 33.43±10.76; range 15 to 60 years) with jaw fractures, 14 were treated with intermaxillary fixation by administration of nickel-chromium wire and arch bar and 14 with titanium miniplates to investigate the genotoxicity of different metal alloys. The outcome variable was the frequency of sister chromatide exchange in peripheral lymphoctyes, determined through the analysis of venous blood samples obtained preoperatively and 4 to 6 weeks postoperatively. The frequency of the average sister chromatid exchange was found to be significantly higher in patients treated with the nickel-chromium intermaxillary fixation devices than those treated by titanium miniplates (1.29±0.29 vs. 0.46±0.39, p<0.001). Although titanium miniplate osteosynthesis is an invasive technique in comparison with the nickel-chromium-containing intermaxillary fixation devices, titanium seems to exert less genotoxic effect than the nickel-chromium alloy. However, this finding should be supported in clinical studies with a larger sampling size.

Fractures of angle of mandible – A retrospective study

AimsThis retrospective study was done to evaluate the efficacy of single miniplate osteosynthesis at superior border of angle of mandible. Material and methodsIn this study 50 patients were treated by single miniplate osteosynthesis according to Champy's principle. Bite force generated was used as a parameter for judging the efficacy of internal fixation. In this article we present our experience over the years in the management of the fractures of angle of mandible based on this model. ResultsMost patients were of 21–30 yrs of age with unilateral angle fracture of mandible except one patient who had isolated bilateral angle fracture. The patients were treated successfully according to Champy's principle of osteosynthesis. There was a progressive improvement in the bite force generated after osteosynthesis. ConclusionsThe angle of the mandible is an anatomically weak and an area susceptible to fracture. The presence of an impacted or partially erupted third molar tooth further weakens it. Angle of mandible is the most common site for fracture however, bilateral angle fracture is very rare and uncommon.Osteosynthesis according to Champy's model led to an early functional improvement as demonstrated by the bite force generated.

THREE DIMENSIONAL BONE PLATING SYSTEM IN THE MANAGEMENT OF MANDIBULAR FRACTURES-A CLINICAL STUDY

Over the past many years, various bone plating systems have been developed to provide stable fixation for the mandible fractures were proposed and performed. The aim of the study was to evaluate efficacy of three dimensional (3-D)titanium mini plates in the management of mandibular fractures, and to analyze structural stability of the fractured bone fragments after fixation, to evaluate the biocompatibility of the three dimensional plating system and the morbidity of three dimensional plating system. Patients and Methods: 20 patients with mandibular fractures required open reduction internal fixation of the fractures using three dimensional mini plate osteosynthesis over a period of 2 yrs. prospectively. Conclusions: Three dimensional titanium miniplates provide good stabilization of fractured fragments in three dimensions due to closed quadrangular geometric shape and ease of contouring and adapting. Less surgical exposure of underlying fracture site is needed, with a minimal traction of the surrounding soft tissue. They are biocompatible and no morbidity seen in our study.

Bloody tears after miniplate osteosynthesis for Le Fort I osteotomy

Le Fort I osteotomy is usually carried out safely as an elective procedure in hospitals. However, minor complications can occur and are related to complex anatomy of the region where nerves, blood vessels and bony canals are present. One of the anatomical structures that can be damaged is the nasolacrimal duct. The patient underwent a Le Fort I osteotomy. After the surgery, blood was observed in her tears of the left eye. A lacrimal duct endoscopy was performed and computed tomography was requested and revealed an accidental perforation of the nasolacrimal duct by a screw of the miniplate osteosynthesis system. The screw (diameter: 2.0mm; length: 7.0mm) was then immediately removed under local anesthesia. The bleeding stopped at the first postoperative day and left no sequelae. Surgeons should be aware of the potential risk for an accidental penetration of the nasolacrimal duct during drilling and installation of the osteosynthesis screws for the rigid internal fixation of Le Fort I osteotomies. When faced with a complaint of bloody tears, the clinician should take a thorough history, then perform a careful eye examination and, when indicated, an otolaryngologic examination. Imaging of the sinuses may be useful when trauma is suspected.

The maxillofacial injuries: A study

Objectives:The aim of this study was to evaluate the incidence and etiology of maxillofacial fractures and also to evaluate different treatment modalities.Study design:The sample consisted of 1,038 patients, with maxillofacial injuries treated at our center from June 2006 to June 2011. Cause, type, site of injury, gender, age and treatment given to them, all these parameter are evaluated.Conclusion:The results of this study exhibit that road traffic accidents is the main reason for maxilla facial injuries followed by fall from height. Maxillofacial injuries are more frequent in male than in female. The mandible was most frequently involved facial bone. The miniplate osteosynthesis was the most widespread of the fixation technique but conservative management of the fractured bone also has a significance importance in treatment modalities.

Stability of the miniplate osteosynthesis used for sagittal split osteotomy for closing an anterior open bite: an experimental study in mini-pigs

Bilateral sagittal split osteotomy of the mandible with counterclockwise rotation of the occlusal plane alone has traditionally been considered the least stable treatment method. Two miniplates on each side of the osteotomy may resolve this problem. The authors compared early vertical and transverse stability of a simple mandibular advancement (group A), mandibular advancement with counterclockwise rotation (CCW) stabilized with one miniplate (group B), and two miniplates (group C) on mini-pig mandibles mounted on a custom-made loading unit. Two miniplates markedly increased the resistance to vertical bite forces. On a 100-N load, a median of dislocation of 0.53mm, 0.46mm, and 0.23mm was achieved in groups A, B, and C, respectively. The difference was statistically significant between groups A and B in comparison with group C. The results of transverse displacement were not statistically significant. The use of two miniplates in larger shifts, as well as in CCW cases, increases stability in the vertical direction.

Transnasal Fixation of NOE Fracture: Minimally Invasive Approach

Nasal fractures may occur in association with other facial injuries like Le-forte II and III and also severe comminuted midface fractures or by themselves. Bony fractures of the nose may involve one or both nasal bones, the frontal process of the maxilla, the bony septum, and in severe trauma the nasal-orbital-ethmoid complex. Treatment of these fractures range from closed reduction and support to open reduction and miniplate osteosynthesis. Purpose of this article is to describe a technique of managing nasal bone fractures associated with midface fractures. Four consecutive patients who sustained nasal bone fracture associated with multiple midfacial fractures were included in the study. Postoperatively, results showed symmetry in the intercanthal to lateral canthal width. Nasofronal angle and nasal prominence was established to the expected position in most of the cases. This technique can be used for Le forte II and III cases where nasal bones to be addressed. This method has shown predictive results with minimal intervention.

Angled Eccentric Osteosynthesis, a New Technique for Simple Mandibular Fractures

Working and balancing sides are subject to torsional and the tensile stresses, respectively. Tension banding principle denotes the principle of plating along the tension line for stable internal fixation on the balancing side of the mandibular fracture, which is the theoretical basis for the miniplate osteosynthesis. On the contrary, Arbeitsgemeinschaft fϋr Osteo - synthesefragen/Association for the Study of Internal Fixation (AO/ASIF) introduced the idea of stable fixation which confirms the stability of the fracture segment across the fracture line of the working side. Merging the principles of the miniplate osteosynthesis and compression osteosynthesis, the author suggests a new technique of angled eccentric osteosynthesis in case of simple mandibular fractures. The drilling holes are eccentrically positioned away from the fracture gap and intentionally angled to each other. The advancement of the miniscrews through these eccentrically angled drill holes will exert an axial load toward the fracture gap providing an interfragmental compressive force.

New exposure technique for management of giant internal carotid artery aneurysm

We are presenting a case of giant internal carotid artery aneurysm (ICAA) managed by a new exposure technique. Following double mandibular osteotomy, the exposure of the entire aneurysm was achieved by mandible mobilization. The aneurysm repair was performed by resection and graft interposition. Mandible bone reconstruction was succeeded via mini plate osteosynthesis. No adverse events were noticed during the 24-month follow-up period. The surgical ICAA management is necessary to prevent severe complications. In cases of aneurysm extension to the skull base, double mandibular osteotomy is a safe technique that facilitates aneurysm exposure and control.