Parasymphyseal Fractures Research Articles

1110 The Cost of Fixing a Fractured Mandible: A Waste Reduction Project

Abstract Introduction Fractured mandibles are a frequent injury seen in the hospital and are commonly caused by interpersonal violence and accidental injury. The need to reduce expenditure in the NHS and redirect funds to where it is most needed is an important topic in recent times. The cost of open reduction internal fixation (ORIF) of mandible fractures can vary by the choice of equipment and technique used. Therefore, this waste reduction project aimed to identify any variation in treatment and minimise this. Method A data collection exercise was performed of isolated mandibular fractures which required surgical intervention. Operation notes were examined from April 2018 to March 2019, with 99 cases found. Information was collected about the number and type of drill bits, plates and screws that were used in the surgery. The expected cost for plating different mandibular fractures including simple, comminuted and multiple fractures was calculated which was compared to the actual average cost by type of injury and operating surgeon. Results The most common injury seen was Parasymphysis fractures, with the average ORIF cost across all surgeons being £239.07. The expected cost to fix this fracture was calculated at £237.95, or £325.31 if intra-operative intermaxillary fixation is used. It was demonstrated that the cost across all injuries was within the expected range and therefore no improvement could be made. Conclusions By limiting the available equipment, stocking the most cost-effective options, and teaching surgeons standardised treatments we are able to reduce the cost and waste in the hospital.

Comparative Study of Miniplate vs Reconstruction Plate in the Management of Bilateral Parasymphysis Mandible Fracture: FEM Analysis.

The present study compared the stability of fracture fragments in the management of bilateral parasymphysis mandible fracture with Miniplate fixation and Reconstruction plate fixation using finite element analysis. 3D FE Mandible model was created using CT scanner. Two bilateral parasymphysis mandible fracture models were created. Model 1 was fixed with Miniplates, and Model 2 was fixed with Reconstruction plate. Loading forces of 120N at molar region and 62.5N at incisor region were applied. These two models were imported to ANSY'S Workbench Software. Miniplate fixation model showed comparatively reduced gap between fragments than Reconstruction plate. But the gap values of both the models were within the physiologic limit of healing under this specific loading. Analytically Miniplates were superior to Reconstruction plate in the management of bilateral parasymphysis fracture. Analytically Miniplates are superior to Reconstruction plate in the management of bilateral parasymphysis fracture. As the masticatory forces were reduced during fracture healing period, both fixations provide satisfactory healing. So both Miniplate and Reconstruction plate can be considered as fixation method for bilateral parasymphysis mandible fracture.

Comparative Evaluation of Conventional Miniplates, Three-Dimensional Miniplates and Lag Screws for Internal Fixation of Parasymphysis Fracture of Mandible-A Double-Blind Randomized Clinical Study.

The aim of this study is to clinically and radiographically evaluate the stability of parasymphysis fracture managed with lag screws, miniplates and 3D miniplates. Ninety- eight patients diagnosed with parasymphysis fracture were treated using lag screws in group 1, two 4-hole miniplates in group 2 and 3D miniplates in group 3. Intraoperative stability and duration of fixation was assessed. Postoperative clinical evaluation was done at 1week, 1month, 3rd month, 6th month and 1year for complications and oral function. Radiological evaluation was done at 3rd and 6th month. Only 92 patients were considered for statistical analysis since 6 patients were lost during follow-up. Road traffic accident (65.3%) was the primary cause of mandibular fractures. Postoperative pain score showed a statistically significant difference after 1week and 1month duration (P value < 0.001). ANOVA test showed VAS was significantly higher at pre-op followed by 1st day and 1week, but no significant difference after 3months in all groups. Radiographic analysis did not show significant difference in approximation of fracture segment among 3 groups after 6months (P-value = 0.117). Chewing efficiency at 6months and occlusion by surgeon evaluation at 3months showed a significant difference (P value < 0.001). Lag screw fixation was technique-sensitive, relatively inexpensive and was less time consuming method when compared to miniplates and 3D plates. Lag screws and 3D plates are superior in reducing the incidence of complications and better in oblique or sagitally displaced mandibular fractures. The online version contains supplementary material available at 10.1007/s12663-021-01647-5.

Comparison of Preauricular Approach Versus Retromandibular Approach in Management of Condylar Fractures

Objectives: Surgical treatment of patients with multiple mandibular fractures involving condylar segments may be a difficult proposition for a maxillofacial surgeon. These fractures can be double or triple fractures of the lower mandible and can also be associated with other fractures of the face. While many authors have suggested that the conventional approach to reducing and stabilizing a mandibular symphysis / para-symphysis fracture is appropriate before addressing a fractured condyle, there is another school of thought that suggests that the condylar segment should be reduced and repaired first. This article aims to review the results of operations where the reduction and fixation of a fractured condyle is performed prior to other associated mandible fractures, and to explore the effectiveness of various surgical methods including preauricular and retromandibular proposed in this case. Place and Duration: In the Oral and Maxillofacial surgery department of Faryal Dental College, Lahore for two-years duration from Jan 2018 to Jan 2020. Material and methods: The study included 60 surgically treated patients with multiple mandible fractures (double / triple), including the condyle component. For treatment of the fractured condylar segments, the preauricular and retromandibular (anterior parotid-transmasseteric) approach was used. Results: Condyle fracture was the first segment to be managed during sequencing of surgical treatment, regardless of the method used. First, good reduction and stabilization have been achieved with limited complications in treating a condyle fracture. Conclusion: While it is the surgeon's prerogative to sort multiple mandible fractures, addressing the condylar segment first provides the operator with a viable alternative to the conventional technique. Key words: condylar fractures, multiple mandibular fractures, preauricular approach, retromandibular approach

Management of mandibular parasymphysis fracture: a case report

Mandibular fractures are among the most common injuries to the facial skeleton. Mandibular parasymphysis fractures lead to the loss of occlusion with step deformity formation. Treatment of mandibular fractures aims to restore occlusion and function and facilitate direct bone healing by adequate reduction and immobilization on the fractured site. We report a mandibular parasymphysis fracture of 17 years old male patient due to the road traffic accidents. Patient reported severe jaw pain during movement and abundant intraoral bleeding was observed. A clinically computed tomography scan of the face with axial, coronal, and 3-D reconstruction was performed, which showed parasymphysis fracture. The following treatment done was the application Arch bar and open reduction internal fixation (ORIF) mini plate under general anesthesia. After access, mandibulomaxillary fixation was performed to ensure satisfactory occlusion after adequate fragment reduction. The fractures were properly fixed with 6 hole and 3 hole, screw 8mm for the left mandibular, and for the right mandibular used 5 hole and 3 hole, screw 8 mm. Mandibular fractures are the most common fractures of facial region and treatment options depend upon the type of fracture of mandible according to the anatomic variations.

Comparative Evaluation of Drill-Free and Self-Tapping Titanium Miniscrews for Semi-Rigid Internal Fixation in Maxillofacial Trauma.

IntroductionConventional semi-rigid fixation systems in maxillofacial trauma use self-tapping titanium miniscrews (STS) that require preliminary drilling of a pilot hole. Although drill-free miniscrews (DFS) accompany these systems, they have not dominated practice despite their allure of improved screw-bone contact and holding power. The COVID-19 pandemic has brought these DFS to light as they avoid aerosol production. The present study has compared DFS to STS in patients being treated with miniplate fixation for maxillofacial trauma to understand their feasibility for maxillofacial fracture fixation. MethodologyThis prospective case–control study sampled 16 patients each with zygomaticomaxillary buttress fracture and parasymphysis fracture of the mandible and grouped alternating patients as case (DFS) and control (STS). Intraoperatively duration of fixation, incidence of screw failures and fragment stability; postoperatively occlusion, neurosensory deficits, teeth vitality and infection and removal rates were evaluated at postoperative week 1, 3, 6, 12 and 24 using Cramer's V test. A P value < 0.05 was considered significant.ResultsIn the 32 patients evaluated, DFS reduced internal fixation time at zygomaticomaxillary buttress (P = 0.001) but not at parasymphysis (P = 0.206). No significant difference in screw failures or fragment stability was observed. Stable occlusion was maintained in all groups with vital teeth and intact neurosensory function, but the summative incidence of infection was significant at week 24 when STS was used at parasymphysis (P = 0.019).DiscussionWhile DFS may facilitate ease of insertion with a single instrument pick-and-screw-in approach, avoiding thermal osteonecrosis and aerosol production, they fail to confer any other clinical advantage.

Comparison between Treatment Outcomes of Titanium Miniplates and Titanium Lag Screws in Fixation of Mandibular Symphysis and Parasymphysis Fractures

Comparison between Treatment Outcomes of Titanium Miniplates and Titanium Lag Screws in Fixation of Mandibular Symphysis and Parasymphysis Fractures

Evaluation of efficacy of lag screw fixation in the management of mandibular parasymphysis fracture

Objectives: Mandibular fractures are treated surgically by either rigid or semi-rigid fixation. The focus of this study was to determine the efficacy of lag screws in treating mandibular parasymphysis fractures. Materials and Methods: We conducted a quasi-experimental study in which ten patients with mandibular sagittal parasymphysis fractures were enrolled. In these patients, two 2.0 mm stainless steel lag screws were installed for open reduction and internal fixation. Throughout the study, patients were examined for occlusion, fracture stability, screw location in relation to vital anatomical structures, reduction precision, maximum mouth opening (MMO), biting efficiency, and several other complications on the 1st day, 1st, 2nd, and 6th weeks postoperatively. Results: All parasymphysis fractures had a good bony union after surgery. One patient had mild occlusal discrepancies postoperatively, and statistical significance was found between preoperative and postoperative occlusion (P &lt; 0.0004). Only one patient had abnormal mobility between the fracture lines postoperatively, with a highly meaningful statistical observation (P &lt; 0.001). The comparative statistical analysis of MMO at different follow-up periods showed highly significant (P &lt; 0.00001) results. Substantial improvement in biting effectiveness yielded a high statistical significance (P &lt; 0.00001). There was no evidence of postoperative complications such as wound infection, wound dehiscence, intraoral screw exposure, or mental nerve injury in any of these patients. Conclusions: Lag screw fixation is a realistic and reliable method of internally fixing mandibular parasymphysis fractures. This technique allows the skilled surgeon to achieve optimum stability and functional healing by using the least amount of material.

An In Vitro Evaluation of a Novel Design Z Plate for Fixation of Mandibular Symphysis and Parasymphysis Fractures-A Finite Element Analysis.

Surgical management of mandibular symphysis and parasymphysis fractures has evolved from rigid fixation to semi-rigid fixation with miniplate osteosynthesis. Various miniplate systems have been developed in recent years including three-dimensional miniplate, microplates and bioresorbable plate, and their advantages and disadvantages have been compared and studied. To overcome the shortcomings of 3D plating system such as difficulty in adaptation and fixation in fractures involving the mental nerve, a novel Z plate has been designed by our institute. An in vitro study was performed to evaluate the biomechanical behaviour of the newly designed Z plate with 3D plate and two-miniplate system using finite element analysis. Our study showed total structural deformation of 0.17mm and 0.31mm of newly designed Z plate after canine loading and molar loading, respectively. The equivalent von Mises force for plate after canine loading had shown the following results-Z plate showed values of 121.3MPa and 58.40MPa after molar loading. Our study concluded that the Z plate produces lowest stresses, lesser total structural deformation, superior stability and support in comparison with the 3D plate and two-miniplate system.

Etiologic Factors Influencing the Pattern of Mandibular Fractures – A Retrospective Study

Objectives: Fractures involving the face, especially the mandible causes aesthetic disfigurement and hampermasticatory function. Ever changing economic and population trends have caused a shift in the etiologicfactors responsible for mandibular fracture. This study records the epidemiology of the mandibular fracturesin Bhubaneshwar region of Odisha and to appreciate the importance of demographics and contribution ofindividual etiological factors towards such injuries.Methods: A retrospective study was conducted during between September 2013 to March 2017, in thedepartment of Oral and Maxillofacial Surgery, Institute of Dental Science. Patients admitted in the facilityfor the treatment of mandibular fractures were included in the study. The data was collected from patientrecords.Results: Out of a total of 197 patients, 90% affected were males, with 42.6% aged between 20-29 years. Themost common cause was Road Traffic Accidents (RTAs)with 83% and para-symphysis fractures was seenin 42.7%. Etiology was found to be influenced by gender using Chi-square (p &lt; 0.05) and site of injury wasfound to highly significant with respect to age.Conclusion: Mandibular fractures were found to be associated with younger aged males and road trafficaccidents. This could be prevented with stringent and safer traffic regulations.

Novel and Affordable Low-Cost Technique for Fixation of Parasymphyseal Fractures in Infants With Unerupted Dentition

Pediatric mandibular fractures are immensely challenging compared to adult fractures. The current update management spectrum ranges from the conservative one in the form of soft diet and regular follow-up, or less invasive surgical intervention by closed reduction and nonrigid fixation, to open reduction and internal fixation with plates and screws. In this study, we investigated the use of a straightforward fabricated mold for the parasymphyseal mandibular fracture in infants with an unerupted dentition. This prospective study was conducted on 8 infants presenting with parasymphyseal fractures with unerupted dentitions in our specialized trauma center. In the operating room before the induction of anesthesia, the authors used a straightforward plastic airway to create a splint. The curved part was split into 2 transverse halves making 2 U-shaped curved pieces that were utilized as a mold. Intraoperatively, the U-shaped piece was placed over the mandible and stabilized with circummandibular wires. This molded airway is used to stabilize the fracture site for 2-3weeks. The average period of follow-up was around 6months. The average time of mandibular fixation was 17.6±2.4 SD (14 to 20) days. The mean of the total operative time was 38.7±3.5 SD minutes, ranging from 35 to 45minutes. Our infants were observed in the outpatient clinic for 6months postoperatively during the follow-up period. There were no noticeable complications nor any interference with tooth eruption or mandibular growth. The results of this study suggest that this technique is straightforward to use and affordable. It does not require a long learning period. It also exhibits the advantage of reducing the cost in many developing countries.

Dental Impression Compound for Mandibular Bilateral Parasymphysis Fracture Reduction

Dental impression compound is a rigid impression material mainly used for prosthetic work in dentistry. It is usually manipulated in a temperature controlled water or air bath. When there is a fracture of bilateral parasymphysis there are chances lingual splaying and thus causing hampering of occlusion and function for the patient. Thus, we propose that impression compound is a quick, economical option for prevention of lingual splaying during bilateral parasymphysis fracture reduction. The hardened impression compound will act as a lingual splint in order to prevent splaying of the lingual cortical bone which will help in ease of fracture reduction of bilateral parasymphyseal region.

A comparative evaluation of parasymphyseal fracture fixation in edentulous patients performed using dynamic navigation systems and Herbert screws with the conventional two-plate method: A study on models

PurposeThe investigators performed this study to compare the rigidity outcomes for minimally invasive fixation of edentulous mandibular parasymphyseal fractures without flap creation using Herbert screws with a dynamic navigation system and the conventional two-plate method. MethodsThe investigators implemented an in-vitro study design, and 20 polyurethane edentulous mandibular models covered with flexible plastic to simulate the gingiva were used. Parasymphyseal fractures were created in all models using a reciprocal saw. In the study group, the fracture segments in each model were planned to be fixed using two 30-mm Herbert screws. The Herbert screws were placed using a screwdriver with the dynamic navigation system guiding the process. In the control group, to simulate open reduction, the fracture fragments were fixed using two 4-hole straight titanium plates and 6-mm titanium screws. All mandibular models on the prepared platform were attached to the biomechanical testing machine. They were subjected to a continuous linear compression until plastic deformation occurred. Displacement resistance was measured once for every model when the displacement reached 1, 3, 5, 10, and 15 mm. Furthermore, the maximum breaking forces that the models could withstand before deformation were measured. Data were analyzed using independent samples t-test. A value of p < .05 was considered statistically significant. ResultsManual examination of the models did not reveal any mobility between the fragments. In all evaluated displacement steps, the models fixed using Herbert screws showed significantly higher resistance to mechanical loading compared to the models fixed using parallel miniplates. ConclusionIn present study, parasymphyseal fracture of edentulous mandible models were fixed successfully using Herbert screws with the dynamic navigation system. The results of this study may encourage future clinical studies.

Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study

The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.

Evaluation of Virtual Surgical Planning and CAD/CAM techniques in Treatment of Mandibular Fractures via Three-Dimensional Patient-Specific Titanium Plates: A Case series.

Background: The study aimed to evaluate and assess the clinical stability and efficacy of 3D patient-specific computer-guided titanium plates (3D-PSP) for accurate reduction and fixation of mandibular fractures. Methods: Ten patients were selected suffering from mandibular body/ para-symphyseal fractures, treated with 3D-PSP. Clinical evaluation included; Patient satisfaction, Pain, Occlusion and Occlusal Bite force. Radiographic parameter evaluated was fracture gap distance. The operating time was also measured during the surgery. Results: The occlusal bite forces showed significant increase at 3 months (p≤0.05) follow up. The fracture gap distance revealed a mean of 0.64±0.40 mm at one week and 0.30±0.38 mm at 3 months. The operating time showed a mean of 8:58±02:39 mins:secs. Conclusions: 3D patient specific plates showed accurate reduction and stability of mandibular fractures with decreased operative time. Superior adaptation on bony surfaces offered increased biting forces and decreased risk of plate fracture and design flexibility avoided mental nerve damage.

A Study of the Mechanical Characteristics of a Mandibular Parasymphyseal Fracture with Internal Fixation Device Subject to Variable Bite Forces: Finite Element Analysis

In recent times, research into mandibular fracture has gained momentum from advances in scanning techniques, software/algorithm developments and improvements, and numerical structural modeling using the finite-element method (FEM). In this work, the FEM is used to model a mandibular fracture (using an inhomogeneous and orthotropic jaw model) simulating the effect of different bite tasks/forces on the stability of the fixated fracture. Specifically, bilateral and unilateral clenches (using muscle data) were studied using a low-profile 3D 4 × 2 hole mini-plate deployed for fracture fixation. Here, the mandible bone was treated as orthotropic and spatially inhomogeneous. Although the results of stress and displacement analyses, for this fixation hardware, indicate sufficient fixation under normal biting conditions, the results show that the unilateral and ipsilateral bites develop, in general, the highest stresses or displacements. Such results can guide post-surgery recommendation on bite behavior.

Mandibular Condylar Fracture in a Professional Soccer Goalkeeper: How to Achieve Early Return-to-Play—A Case Report

Sport-related mandibular fracture is a common injury in the field of maxillofacial surgery. However, the treatment of mandibular condylar fractures in professional soccer goalkeepers is rarely reported. A 32-year-old male professional soccer goalkeeper was referred for malocclusion after collision with an opponent player during a game. The patient’s mandible was displaced between the left lower lateral incisor and left lower canine. Computed tomography showed right condylar base fracture with medial displacement and left para-symphysis fracture. Internal fixation using retromandibular anterior trans-parotid approach via 25-mm skin incision immediately below the earlobe and intraoral vestibular approach were performed under general anesthesia 2 days after the injury. The patient was discharged without complications 3 days after surgery, with mandibular protrusion and diduction exercises with limitation of mouth opening. Soft diet and limitation of mouth opening was performed for 4 weeks after surgery. To achieve early return-to-play, rehabilitation based on Fowell and Earls’ return-to-play guidelines following facial fractures was started, with moderate exercise 5 days after surgery, and progressively full exercise without contact 8 days after surgery. He started normal team training with individualized jaw-guard 4 weeks after surgery. His body weight decreased by 2.2 Kg 1 week after surgery, gradually recovered, and became normal 4 weeks after surgery. The patient returned to a game 2 months after surgery. This case report can be a reference case in condylar fractures of professional soccer players, as the available scientific literature is limited with regard to return-to-play after maxillofacial fracture in professional athletes.

Conduta frente a uma fratura mandibular parassinfisária bilateral – relato de caso

The anterior region of the mandible is a site of insertion of the muscles that support and position the tongue superiorly and anteriorly in the oral cavity. The bilateral fracture pattern in mandibular parasymphysis can result in loss of this support and present of the lingual musculature, putting the upper airway patency at risk. This study aimed to report a case of bilateral parasymphysis fracture, emphasizing therapeutic management in the conduction of the case. Patient victim of physical aggression presented to the hospital emergency unit, showing atypical mobility in the anterior segment of the mandible. The CT scan of the face confirmed the presence of bilateral fracture in the mandibular parasymphysis region. After diagnosis, the patient was hospitalized and surgically approached within 48 hours for open reduction and rigid internal fixation. In the evaluation of mandibular fractures, it is necessary to pay attention to the configurations that are potentially fatal. Fracture of the mandible in the anterior region can impair the patient’s respiratory competence, despite the fact that airway instability is not always present. Thus, the management of cases in immediate care must be individualized, and the patient monitored until definitive treatment.

A Prospective Randomized Study to Assess the Quality of Life in Post-Operative Recovery Phase in Patients Undergoing Surgery for Isolated Vertically Undisplaced Mandibular Parasymphysis Fracture Using Twin Mix Solution.

Trauma is a major cause for facial fractures commonly encountered by maxillofacial surgeons. Mandible is commonly involved in facial trauma resulting in an isolated fracture or associated with other facial bones due to its prominent location in the facial skeleton. This study was undertaken to investigate the quality of life (QoL) post-operatively in patients diagnosed with undisplaced parasymphysis fracture who underwent open reduction and internal fixation (ORIF) under local anesthesia (LA) using the twin mix (TM) solution. A prospective randomized clinical study was conducted among 40 patients aged between 20-55years requiring ORIF for unilateral vertically undisplaced parasymphysis fracture under LA. Group A patients (n = 20) received conventional LA solution with adrenaline, and Group B patients (n = 20) received freshly prepared TM solution for their surgical intervention as a day care procedure. Various parameters such as jaw function, ability to masticate and labialis activity (lower lip pout) were assessed. The data were collected and analyzed applying student's t test, Shapiro-Wilk test using SPSS software. All the 20 patients in Group B who received TM solution exhibited better jaw function and mouth opening with a mean score of (±SD) of 4.55 (±0.944). They also exhibited reduced difficulty in mastication and ability to purse the lower lip on third post-operative day as compared to the patients in Group A. No complications were observed among the patients post-operatively in both the groups of this study. TM solution proves to be superior as compared to the conventional LA solution as the former offers an improved clinical outcomes enhancing the QoL post-operatively in patients undergoing ORIF for undisplaced parasymphysis mandibular fracture.

Stabilization of anterior mandibular fracture using different osteosynthesis devices: perioperative clinical notes

There is still no definitive consensus about the ideal technique in the treatment of anterior mandibular fractures. Therefore, this study aimed to determine clinical and radiographic outcomes of four different internal fixation devices used for this type of fractures. This was a cohort study that included 64 fracture cases. Fractures were fixed using four types of open reduction internal fixation devices: single 2.0-mm mini-locking plates, double 2.0-mm miniplates, double lag screw and double microplates. Investigated variables were surgical duration, wound dehiscence, infection, occlusion, mouth opening, patient compliance, nerve damage and postoperative oedema. Male patients constituted 90.6% of the study sample. A proportion of 33% of the fractures were single symphysis and 67% were parasymphysis fractures. The most time-saving technique was the lag screw followed by microplate with mean/SD of 50.65 ± 4.152min. Wound dehiscence occurred in 4.7% and 3.1% of the miniplate and the mini-locking groups respectively. Miniplate and microplate groups had small interfragmentary space at 1-month postoperative radiographs, while mini-locking and lag screw groups had no extra-callus formation. The double lag screw and the single mini-locking plate are the most effective devices for primary bone healing of displaced mandibular symphysis/parasymphysis fractures which is attributed to their enhanced stability. Miniplates and microplates gave functionally well-balanced fixation and were also associated with higher patient convenience due to improved adaptability and relatively lower cost than locking plates. Cost-effectiveness of lag screws in comparison to bone plates is particularly beneficial in low-income countries.