Resorbable Plates Research Articles

The “Rocky” Factor: Minimizing Globe Injury in Subsequent Orbital Floor Fractures in Repeat Offenders

Background: Recurrent or repeat orbital floor and/or medial wall fractures may have an increased risk of globe injury and vision loss. To see if the initial orbital floor repair technique and/or chosen material for reconstruction impact the result, we studied repeat offenders who engage in: (1) repeat assaults, (2) unprotected sports injuries, or (3) seizure disorders. Methods: From 715 patients who underwent traumatic orbital floor repair over an 18-year period, 58 “repeat offenders” suffered a subsequent orbital fracture and were studied. Type of repair and outcomes including globe injuries were documented. Results: Repeat offenders who had a second orbital fracture had initial repairs with: resorbable plates (63.8%), titanium mesh (12.1%), and split cranial bone grafts (14%). More significant globe injuries occurred when initial repair was with titanium plates (86%) and bone grafts (14%) compared to resorbable plates (0%). Of the total group with initial orbital fractures and repair, 15% were categorized as “at risk” to be repeat offenders based on their medical history and activity. Of the “repeat offenders” who had an additional orbital fracture, 95% (50/58) fell into the “at risk” category for “repeat offending.” Conclusion: Resorbable plate orbital floor and/or medial wall fracture repair may offer less significant globe injury for repeat offenders at risk for subsequent orbital trauma.

Effectiveness of bone plate reduction combined with resorbable plate fixation in the treatment of large mandibular cysts.

This study aims to observe the clinical effect of bone plate reduction in combination with a resorbable plate on large mandibular cysts. Between October 2017 and September 2022, patients with large mandibular cysts in the presence of labial and buccal cortical bone were involved in the study. Intraoral approach was performed for bone plate reduction. Cone beam computed tomography (CBCT) scan was reviewed at 3, 6, and 9 months postoperatively to observe postoperative complications. Osteogenic results were assessed at these times to determine the clinical outcomes of this procedure. Eleven cases with large mandibular cysts in the presence of cortical bone were evaluated. The average thickness of the cortical bone on the labial and buccal sides was measured to be about (1.98±0.37) mm before surgery, with a mean value of (0.73±0.17) mm at the thinnest part of the plate and up to 0.51 mm at the thinnest part of the plate. The cystic cavities were well revealed during the surgeries, which were completed successfully. Postoperatively, the wounds healed in one stage without infection. The percentages of cyst shrinkage were 20.01%, 41.76%, and 73.41% at 3, 6, and 9 months after surgery, respectively. Quantitative measurement of bone mineral density in the jaws by CBCT with MIMICS software. The bone mineral densities of the adult bone were 313.78, 555.85, and 657.45 HU at the 3, 6, and 9 month time intervals, respectively. No significant change in the patient's maxillofacial appearance were observed from the preoperative period as assessed by the patient's and observer's visual analog scale. Bone plate reduction is an effective treatment for large mandibular cysts of the oral and maxillofacial region with the presence of cortical bone.

Reconstruction of Orbital Wall Fractures with a Combination of Resorbable Plates and Antibiotic-Impregnated Collagen Sheets.

(1) Background: Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. (2) Methods: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. (3) Results: significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02). (4) Conclusions: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

Endothelial SMAD1/5 signaling couples angiogenesis to osteogenesis in juvenile bone

Skeletal development depends on coordinated angiogenesis and osteogenesis. Bone morphogenetic proteins direct bone formation in part by activating SMAD1/5 signaling in osteoblasts. However, the role of SMAD1/5 in skeletal endothelium is unknown. Here, we found that endothelial cell-conditional SMAD1/5 depletion in juvenile mice caused metaphyseal and diaphyseal hypervascularity, resulting in altered trabecular and cortical bone formation. SMAD1/5 depletion induced excessive sprouting and disrupting the morphology of the metaphyseal vessels, with impaired anastomotic loop formation at the chondro-osseous junction. Endothelial SMAD1/5 depletion impaired growth plate resorption and, upon long-term depletion, abrogated osteoprogenitor recruitment to the primary spongiosa. Finally, in the diaphysis, endothelial SMAD1/5 activity was necessary to maintain the sinusoidal phenotype, with SMAD1/5 depletion inducing formation of large vascular loops and elevated vascular permeability. Together, endothelial SMAD1/5 activity sustains skeletal vascular morphogenesis and function and coordinates growth plate remodeling and osteoprogenitor recruitment dynamics in juvenile mouse bone.

Quantitative analysis of change in bone volume 5 years after sinus floor elevation using plate-shaped bone substitutes: a prospective observational study

PurposeTricalcium phosphate (TCP) has osteoconductive ability and reportedly offers similar clinical results as autogenous bone grafts in dental implant treatment. However, few reports quantify temporal changes in augmented bone volume after sinus augmentation. We aimed to establish a three-dimensional (3D) quantification method to assess bone volume after sinus augmentation and to evaluate biocompatibility of the TCP plate.MethodsMaxillary sinus floor augmentation was performed employing the lateral window technique, and plate-shaped β-TCP (TCP plate) was used instead of granular bone grafting materials. After lifting the sinus membrane, the TCP plate was inserted and supported by dental implants or micro-screws. The changes in bone volumes in the maxillary sinus before and after surgery were recorded using cone-beam computed tomography, saved as Digital Imaging and Communications in Medicine-formatted files, and transformed to Standard Triangle Language (STL)-formatted files. Pre- and post-operative STL data of bone volume were superimposed, and the augmented bone volume was calculated. Moreover, changes in bone volumes, TCP plate resorption rates, and bone heights surrounding the implants were three dimensionally quantified.ResultsFifteen implants in nine subjects were included in this study. TCP plates secured long-term space making, with results similar to those of granular bone substitutes. Newly formed bone was identified around the implant without bone graft material. TCP plate was absorbed and gradually disappeared.ConclusionsA novel 3D quantification method was established to evaluate changes in bone volume. Clinical application of TCP plate in sinus augmentation could be a better procedure in terms of prognosis and safety.

Case Report: Management of pediatric Le Fort and mandibular fracture with a modified cap splint

Pediatric facial fractures are rare and make up 5–15% of all facial fractures. The low incidence of facial fractures among children is due to physiological and environmental factors such as greater resilience of the pediatric skeleton, higher bone to tooth ratio, direct parental supervision and limited outdoor activity.1 In children of 5–10 years of age nasal fractures are by far the most frequent (58.6%), followed by mandibular fractures (21.5%). Orbital (9.5%), frontal (5.1%), and midfacial (3.8%) fractures are next in frequency2. Le Fort fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. In the mandible condylar fracture is the most common (38.9%) followed by angle (20.6%), parasymphysis (18.3%), body (15.3%) and symphysis (5.3%).3 Facial fractures are more common in boys, though this varies greatly from 1.1:1 to 8.5:1.4 The majority of facial fractures in children result from falls (7.8–48%) and sports-related injuries (4.4–42%).5 In primary or mixed dentition, the placement of internal fixation hardware is challenging due to the risk of injuring unerupted permanent tooth follicles. The use of resorbable plates and screws offer a potential solution to the growing pediatric facial bone as the standard titanium fixation systems carry the risk of translocation, growth restriction, and dental injury. Dental splinting or suspension wires can also be used in place of direct plating. Fortunately, mild malocclusion at this age has the potential to be improved through bony remodeling, the eruption of permanent dentition, compensation of the mastication mechanism, and posttraumatic orthodontia.6 Accordingly, the goal of treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion with minimal residual functional and esthetic impairment.

Usefulness of resorbable plate in auricular elevation in two-stage microtia reconstruction.

Achieving a well-reconstructed retroauricular sulcus with satisfactory projection and a sufficiently deep retroauricular sulcus is important and at the same time challenging. The selection of the support material is crucial to obtain a sustainable, deep sulcus. The costal cartilage is the conventional material of choice. However, risk of slippage of inserted cartilage and donor site morbidity exists. Resorbable plates are durable, easy to secure and can be easily modified into desired shape. The current study aimed to demonstrate the effectiveness of using a resorbable plate for auricular elevation. Retrospective review of patients who received auricular elevation with resorbable plates from December 2020 to October 2022 was performed. Patients demographics, number of inserted plates and screws, postoperative complication were analyzed. Of 65 patients with microtia who underwent auricular reconstruction, resorbable plates were applied to 12 patients. Mean follow up period was 198 (range, 86-360) days. Auricular elevation was performed with one plate at cavum conchae and remnant rib cartilage at the helix in 10 patients (87)%. Two patients had resorbable plate as support material at the both sites. Regarding postoperative complications, there were no hematoma, seroma, plate exposure or plate fracture. Two patients suffered wound problems. One patient recovered only with conservative management. The other healed completely after debridement and intravenous antibiotics administration without undesired change of shape of ear. We suggest using resorbable plates as an ideal support material, as it can provide firm support to achieve appropriate depth of sulcus without excessive bulk.

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

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

Buccal plate preservation with immediate post-extraction implant placement and provisionalization in anterior maxillary tooth: Preliminary results of a new technique using Teruplug collagen

BackgroundBone resorption and remodelling are inevitable results of dental extraction and begin immediately after the extraction procedure. The buccal plate is especially predisposed to these phenomena, and if affected, may result in an increased risk of facial soft-tissue recession and other adverse clinical effects that may decrease the predictability of implant placement or impair the final aesthetic result. PerposeThe application of Teruplug collagen to prevent buccal plate resorption technique is a new technique aimed at maintaining or improving the appearance of the soft and hard tissues after dental extraction procedures. MethodsAll patients underwent teeth extraction and buccal plate preservation followed by immediate implant placement and provisionalisation using Teruplug collagen. The distance from the external surface of the labial bone to the buccal surface of the implant was measured immediately after placement 6 months and 12 months using computed tomography(CT) images. The aesthetic outcome of 35 implant supported dentures was evaluated by the pink aesthetic score (PAS). Patient aesthetic satisfaction was investigated by a visual analogue scale (VAS). ResultsIn a four-wall intact socket, this approach is aimed at optimising the ability of the Teruplug collagen to improve regeneration and maintain or improve labial/buccal contours without interfering with the natural healing capability of the alveolus after extraction and implant placement. During the different observation period, there were no major biologic or prosthodontic complications as determined by a clinical examination at each follow-up visit. ConclusionsBuccal plate preservation as described may help to maintain or improve the appearance and contours of the ridge after tooth extraction, laying the groundwork for optimal functional and aesthetic replacement of the missing tooth with an implant-supported prosthesis.

A Novel Method to Fix Paediatric Mandibular Fracture using 2-0 Polyglactin Suture: A Technical Note.

Reduction and stabilisation of fractures at the earliest is valuable in the paediatric age groups. This novel technique focuses on stabilisation of the fracture fragments using vicryl, which has an added advantage to conventional plating and wiring. This study aimed on a novel cost-effective technique of stabilising the paediatric mandibular fracture using 2-0 resorbable polyglactin 910 suture with minimal trauma to tooth buds and bone and adequate stability. After raising a full-thickness mucoperiosteal flap, the fracture segments are identified and reduced. 1.6mm drill bit is used to make holes through the buccal cortex on either side of the fractured segment in an anteroposterior direction. The patency of holes is checked by passing a long 26-gauge wire. The proximal end of the wire is bent into a loop, a 2-0 resorbable polyglactin suture (vicryl) is passed through this loop and the loop is pressed in place to lock the suture. The wire with the attached suture is pulled through the distal end. Once the suture is secure in place, the 26G wire is cut, and the two ends of sutures are knotted and stabilised. The mucoperiosteal flap is then closed. A novel method of stabilisation of paediatric fracture without hampering the tooth and jaw growth, especially in the financially unstable population. 2-0 polyglactin 910 suture is cost-effective, $2 US, compared to resorbable plates costing about $150 US, and easily available. Polyglactin 910 takes 40-60 days for resorption, and half-life tensile strength is 2 weeks; thus, it gives adequate stability and time for callus formation and does not damage the tooth buds or bone by cutting through them.

Infants With Trigonocephaly Treated With Fronto-Orbital Remodelling and Endocortical Positioning of Resorbable Plates-A Retrospective Cohort Study Including 101 Patients.

Fronto-orbital remodeling is the gold standard for surgical treatment of metopic synostosis in many craniofacial centers. For fixation, resorbable materials are widely used. Because of swelling during resorption, the positioning of the plates can be relevant. Therefore, the goal of this study was to investigate whether there are limitations to endocortical positioning of resorbable plates. In this retrospective study, all patients with metopic craniosynostosis resulting in trigonocephaly, who were treated with a standardized fronto-orbital remodeling and endocortical positioning of resorbable plates, between February 2012 and December 2019 were included. The endpoint of this study was the postoperative complications that can be attributed to the material used. A total of 101 patients, who were treated at our unit, could be included with a male predominance, 81 (80.2%) boys versus 20 (19.8%) girls. Surgery was performed at a median age of 9 months (±2.56). No complications were seen related to resorbable plates. All patients of our study population were categorized as Whitaker classification I and II. This study shows that the risk level in using endocortical resorbable plates positioned on the inner surface of the bone is low. From an aesthetic point of view, we could not detect any disadvantage.

Comparison of Craniosynostosis Surgery Outcomes Using Resorbable Plates and Screws versus Absorbable Sutures in Children with Craniosynostosis.

Previously, absorbable screw and plate systems were widely used in craniosynostosis surgery in Iran, but now, due to the establishment of economic sanctions, the importation of these tools into the country has become difficult. In this study, we compared the short-term complications of cranioplasty surgery in craniosynostosis using absorbable plate screws with absorbable sutures. In this cross-sectional study, 47 patients with a history of craniosynostosis who underwent cranioplasty at Tehran Mofid Hospital, Tehran, Iran from 2018 to 2021 were divided into two groups. For first group (31 patients) we used absorbable plate and screws, and for the second group (16 patients) absorbable sutures (PDS). All operations in both groups were performed by the identical surgical team. Patients followed up for consecutive post-operative examinations in the first and second weeks and 1, 3, and 6 months. Data were analyzed using SPSS software version 25. The results did not show any short-term or medium-term complications in either group. No recurrences were observed. In Whittaker classification, 63.8% were Class I, 29.8% were Class II, 6.4% were Class III, and 0% were Class IV. There was no statistically significant relationship between the type of treatment (screw and plate or absorbable suture) and higher Whitaker. There was also no statistically significant relationship between type of craniosynostosis and higher Whittaker. The absorbable sutures can be considered as valuable and cost-effective tools in the fixation of bone fragments in craniosynostosis surgeries by surgeons.

Efficacy of bioresorbable plating system in the treatment of pediatric maxillary fractures: A short clinical study.

The aim of this study was to evaluate the efficacy, stability, and clinical outcomes of a bioresorbable plating system in the treatment of pediatric maxillary fractures. Twenty pediatric patients with maxillary fractures (13 males and 7 females) were included in this study. The 1.5- and 2.0-mm resorbable plates were used and secured with monocortical resorbable screws 6 mm and 7 mm in length. All patients were followed up for 6 months. Clinical parameters, such as pain, swelling, soft-tissue infection, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. Fall from height (50%) was the most common cause of etiology, followed by road traffic accidents (35%). Maxillary alveolar # (40) was the most common fracture site, followed by nasal complex # (25%) and zygomatic complex # (25%). Appropriate fixation and adequate primary bone healing was achieved in 100% of the cases. Few minor complications were observed: (1) soft-tissue infection (5%) and (2) paresthesia (10%). There was a significant increase in bite force in the incisor and molar regions. Observation in clinical parameters shows that there was a significant reduction in postoperative pain and swelling at different follow-up periods. Bioresorbable plating system is used as a load-sharing plate in a semirigid fixation technique after anatomic fracture reduction. Although its high costs limit its feasibility for use low infection rates, minimized second surgery for implant removal attracts its use. 1.5- and 2-mm resorbable plating system along is a good treatment modality for moderately displaced maxillary fractures in pediatric patients. Larger sample size and longer follow-up studies are required for conclusive results.

The socket shield technique and its complications, implant survival rate, and clinical outcomes: a systematic review.

The aim of this systematic review was to evaluate the effectiveness of the socket shield technique (SST), an innovative surgical method introduced in 2010, for reducing buccal bone plate resorption. The review was conducted following the PRISMA guidelines. Clinical studies conducted in humans and investigating the SST were searched on PubMed (MEDLINE), Embase, Web of Knowledge, and Google Scholar in November and December 2021. The implant survival rate, percentage of complications, and clinical parameters (marginal bone loss [MBL], pink esthetic score [PES], and buccal bone plate resorption [BBPR]) were analyzed using the collected data. The initial search resulted in 132 articles. After article screening, the full texts of 19 studies were read and 17 articles were finally included in the review. In total, 656 implants were installed with the SST. Nine of the 656 implants experienced failure, resulting in an implant survival rate of 98.6%. The percentage of complications was about 3.81%. The analysis of clinical parameters (MBL, PES, and BBPR), showed favorable results for the SST. The mean MBL in implants placed with the SST was 0.39±0.28 mm versus 1.00±0.55 mm in those placed without the SST. PES had a better outcome in the SST group, with an average of 12.08±1.18 versus 10.77±0.74. BBPR had more favorable results in implants placed with the SST (0.32±0.10 mm) than in implants placed with the standard technique (1.05±0.18 mm). The SST could be considered beneficial for preserving the buccal bone plate. However, since only 7 of the included studies were long-term randomized controlled trials comparing the SST with the standard implant placement technique, the conclusions drawn from this systematic review should be interpreted with caution. PROSPERO Identifier: CRD42020180637.

Effectiveness of immediate fixation after cranial distraction osteogenesis

Distraction osteogenesis (DO) is an established safe and effective treatment of craniosynostosis (CS) deformities. However, conventional methods demonstrate some complications, such as long-term maintenance of the distractor and relapse after distractor removal. Only a few studies have overcome these limitations. Therefore, we hypothesized that placing a resorbable plate after removing the distractor will provide additional stability to the newly formed bone, shortening the consolidation period and minimizing relapse. Twenty-six children diagnosed with CS who underwent DO between 2000 and 2019 were retrospectively analyzed. A resorbable plate was fixed across the regenerated bone when distractors were removed. The consolidation period and complication rate were obtained from medical records, and both two- and three-dimensional analyses were performed to obtain relapse rate and brain volume changes using three-dimensional computed tomography. Among 26 patients, the average consolidation period was 90.75±23.75 days in the conventional group (n=11) and 22.77±8.69 days in the intervention group (n=15). In the two-dimensional analysis, the relapse rate was lower in the intervention group. Moreover, in the three-dimensional analysis, the relapse rate of unilateral CS between the affected and unaffected sides was lower in the intervention group. The conventional group had more complications (skin defect and distractor exposure). Resorbable plate placement after distractor removal helps shorten the consolidation period and prevent relapse in pediatric patients with cranial DO. It reduces complications and shows stable results in terms of cranial morphology and symmetric brain growth in patients with CS.

An Alternative Location for Fixation of Subcondylar Fractures With 2 Resorbable Plates.

Mandibular subcondylar fractures can be fixed with 2 titanium plates or 2 resorbable plates. However, when a wider resorbable plate is used, there might be insufficient space on subcondylar region. The authors have tested the back of the condyle as an alternative location for the wide resorbable plate. The fractured condyle was accessed through the preauricular approach. The first resorbable plate (4 hole plate, extended; 2mm Inion OTPSTM) was contoured around the posterior edge of the mandibular ramus. The upper and lower parts of the very resorbable plate were twisted into 2 different planes. The upper part was adapted and then fixed on the back of the condylar neck. And the lower part was fixed on the lateral surface of the posterior edge of the mandibular ramus. The second plate (4 hole plate; 2mm Inion OTPSTM) was put below the mandibular notch as usual. Postoperative computed tomography confirmed a stable anatomical reduction of condyle. One-year follow-up showed good fracture healing. The authors believe that the back of the condyle is particularly suitable for wider resorbable plate. And this alternative site on the back of the condyle is also feasible in cases where the conventional site is not available.

Prospective randomized trial of metal versus resorbable plates in surgical stabilization of rib fractures.

Surgical stabilization of rib fractures has gained popularity as both metal and resorbable plates have been approved for fracture repair. Is there a difference between metal and resorbable plate rib fixation regarding rib fracture alignment, control of pain, and quality-of-life (QOL) scores (Rand SF-36 survey)? Eligible patients (pts) included 18 years or older with one or more of the following: flail chest, one or more bicortical displaced fractures (3-10), nondisplaced fractures with failure of medical management. Patients were randomized to either metal or resorbable plate fixation. Primary outcome was fracture alignment. Secondary outcomes were pain scores, opioid use, and QOL scores. Thirty pts were randomized (15 metal/15 resorbable). Total ribs plated 167 (88 metal/79 resorbable). Patients with rib displacement at day of discharge (DOD) metal 0/14 (one pt died, not from plating) versus resorbable 9/15 or 60% ( p = 0.001). Ribs displaced at DOD metal 0/88 versus resorbable 22/79 or 28% ( p < 0.001), 48% in posterior location. Patients with increased rib displacement 3 months to 6 months: metal, 0/11 versus resorbable, 3/9 or 33% ( p = 0.043). Ribs with increased displacement 3 months to 6 months metal 0 of 67 versus resorbable 6 of 49 or 12.2% ( p < 0.004). Pain scores and narcotic use at postoperative Days 1, 2, 3, DOD, 2 weeks, 3 months and 6 months showed no statistically significant difference between groups. QOL scores were also similar at 3 months and 6 months. Trauma recidivism in outpatient period resulted in fracture of resorbable plates in two pts requiring a second surgery. Metal plates provided better initial alignment with no displacement over time. Clinical outcomes were similar regarding pain, narcotic use, and QOL scores. Routine use of resorbable plates for posterior rib fractures is not warranted. Lateral repairs were technically most feasible for using resorbable plates but still resulted in significant displacement. Resorbable plates may not maintain rib alignment when exposed to subsequent injury. Therapeutic/Care Management; Level II.

Inanimate surface contamination of SARS-CoV-2 during midfacial fracture repair in asymptomatic COVID-19 patients

PurposesTo evaluate inanimate surface contamination of SARS-CoV-2 during midfacial fracture repair (MFR) and to identify relevant aggregating factors. MethodsUsing a prospective non-randomised comparative study design, we enrolled a cohort of asymptomatic COVID-19 patients undergoing MFR. The predictor variables were osteofixation system (conventional titanium plates [CTiP] vs. ultrasound-assisted resorbable plates [USaRP]). The main outcomes were the presence of SARS-CoV-2 on four different surfaces. Other study variables were categorised into demographic, anatomical, and operative. Descriptive, bi- and multivariate statistics were computed. ResultsThe sample consisted of 11 patients (27.3% females, 63.6% right side, 72.7% displaced fractures) with a mean age of 52.7 ± 20.1 years (range, 19–85). Viral spread was, on average, 1.9 ± 0.4 m. from the operative field, including most oral and orbital retractors’ tips (81.8% and 72.7%) and no virus was found at 3 m from the operative field, but no significant difference was found between 2 osteofixation types. On binary adjustments, significantly broader contamination was linked to centrolateral MFR (P = 0.034; 95% confidence interval [CI], 0.05 to 1.02), and displaced MFR > 45 min (P = 0.022; 95% CI, 0.1 to 1.03). ConclusionsUSaRP, albeit presumably heavily aerosol-producing, cause similar SARS-CoV-2 distribution to CTiP. Non-surgical operating room (OR) staff should stay ≥ 3 m from the operative field, if the patient is SARS-CoV-2-positive. Enoral and orbital instruments are a potential virus source, especially during displaced MFR > 45 min and/or centrolateral MFR, emphasising an importance of appropriate patient screening and OR organisation.

Rigid versus Resorbable Plate Fixation in Fronto-Orbital Advancement in Unicoronal Stenosis - A Retrospective Study.

Introduction:Rigid plating fixation (RPF) and resorbable plating systems (RPS) advanced the field of reconstruction in craniomaxillofacial region. However, their performance in patients, particularly the effect on bone remodeling at site of hardware placement is not much documented. This manuscript aims to compare the performance of RPF and RPS in a cohort using a retrospective audit of case records.Methods:Archival records were searched for patients who had undergone cranial metal-RPF or RPS or combination for the correction of craniofacial deformities following inclusion-exclusion criteria. From records, data of the quality and quantity of bone formed along the site of plate fixation as compared with the adjacent site, accommodating or facilitating brain growth, and persistence of bone deformity at the site of hardware placement were collected at the end of the follow-up period. A total of 128 sites from 18 individuals (6 with exclusive metal-RPF and 12 with RPS) mean age of 7.45 ± 7.28 (Median 4; IQR of 8.88;2.6–11.5) who underwent cranial bone remodeling surgery formed the study group.Results:There was a statistically significant difference between the RPF and PRS system at the fronto-orbital suture (P = 0.002) and coronal suture (P = 0.036) with bone quality and quantity.Discussion:The RPF system was rigid but had a set of issues, while RPS has advantages and limitations. The qualitative difference in between the two systems is different. Due to inherent dissimilarity, the two systems cannot be interchanged and due diligence has to be exercised while deciding on the system. More prospective studies are needed to validate the findings.

Experience with Resorbable Plates for Fixation of Mandible Fracture. A Prospective Study of 10 Cases.

Aim:This study aims to evaluate the efficacy of resorbable plates for the fixation of mandible fracture.Materials and Methods:10 cases of fracture mandible were treated with resorbable plates using the Inion CPS system. Patients were evaluated during their entire hospital stay and recalled on 1st, 4th, and 8th postoperative weeks. A thorough evaluation was done at the recall visits for any surgical and postoperative complications such as infection, malocclusion, neural abnormalities, wound or suture dehiscence, segmental mobility, foreign body reaction, and pain on biting. Bite force measurements were taken to evaluate the return of function.Results:Clinical union of the fracture was noted at the 8th week follow-up examination for all cases. There were swelling and pain at the operated site at 8th week follow-up for one patient, which was managed conservatively. The mean bite force was recorded for different regions and it increased over the entire follow-up period progressively.Conclusion:These plates and screws are an essential tool in the treatment of mandibular fractures owing to benefits such as biodegradability, biocompatibility, and the ability to be eliminated via the body's natural processes.