Rigid Fixation Methods Research Articles

Functional outcome in case of surgically and conservatively treated bilateral distal end radius and scaphoid fracture: a rare case report

Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Proper preoperative evaluation is a must to know the orientation of the fracture. Treatment must be based on displacement of the fracture. If fracture is displaced, internal fixation is needed but if its stable with minimal displacement, we can conserve it. A patient with displaced distal radius fractures and displaced scaphoid fracture on one side, along with displaced distal end radius fracture and undisplaced scaphoid fracture on the other side, was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating on the right side and below elbow cast in cup holding position on the left side which was non-dominant. The approach to treating fractures hinges on several factors: the specific location and alignment of the fracture, the patient's characteristics, and the surgeon's expertise. For fractures in the distal radius and scaphoid, employing a rigid internal fixation method allows for the early initiation of active wrist rehabilitation, eliminating the necessity for wrist immobilization using a plaster cast or external skeletal fixation. On the other hand, a conservative treatment approach involving a below-elbow cast offers certain advantages, such as minimal blood loss and fewer complications related to wound healing, particularly for undisplaced fractures, especially when they occur in the non-dominant hand.

Comparative study between bi-columnar plating as opposed to double tension band osteosynthesis in inter-condylar distal humerus fractures in adults

Introduction: Distal humerus fractures with inter-condylar extension are unusual in Orthopaedic practice. The treatment for the same has been defined inside the literature and consists of parallel and orthogonal fixation with the aid of using plates. The study aimed to observe the effectiveness of “double tension band wiring” method for the remedy of distal humerus fractures with inter-condylar extension and compare the effects with studies related to its treatment with locking plates. Materials and methods: 50 patients, all presenting with closed fractures of the distal humerus, out of them 20 have been dealt with double tension band wiring procedure and 30 were treated with locked plates fixation method. Results: Out of 50 cases treated with these 2 methods of internal fixation, rigid fixation and union was achieved in each and every patient. The mean duration of use of tourniquet during surgery was 65 minutes with minimum of 54 minutes and maximum of 110 minutes. Complete radiological union of the fracture was seen at a mean duration of 11 weeks after the surgery (9-15 weeks). Average range of motion was 103 degrees with maximum range of motion of 110 degrees (20-130 degrees) and minimum of 65 degrees (25-90 degrees). Good results were obtained in both the groups in our study. Conclusion: Both the approaches of treatment gave good results. Union became accomplished in almost all instances. However, implant related difficulty become more with locked plates. Double tension band is a reliable, easier, inexpensive and safe technique of fixation of inter-condylar fractures of distal humerus in adults.

Combined Intramedullary Pinning for the Stabilisation of Distal Diaphyseal and Metaphyseal Femoral Fractures in Five Skeletally Immature Dogs

AbstractThe aim of this retrospective case series was to evaluate outcomes of distal normograde intramedullary pinning combined with dynamic intramedullary pinning for the stabilisation of distal diaphyseal and metaphyseal femoral fractures in five juvenile dogs. Medical records and radiographs were reviewed to evaluate signalment, interval from injury to surgery, fracture classification, concurrent injuries, apparatus, fracture healing and any complications. Final follow-up at skeletal maturity consisted of orthopaedic examination and orthogonal radiographs of bilateral femurs. Radiographs were evaluated for osteoarthritis, femoral length and alignment. Three of four dogs that returned for short-term follow-up healed without complication at 4 weeks postoperatively. One dog experienced pin migration and delayed union, requiring pin removal. All four dogs that returned for final follow-up demonstrated excellent limb function based on owner assessment and orthopaedic examination. Radiographic evaluation revealed mild stifle osteoarthritis in two dogs. All dogs demonstrated continued growth of the affected femur with mild discrepancies in length compared with the contralateral femur at skeletal maturity. Two dogs developed subclinical femoral neck retroversion relative to the normal contralateral limb. Combined intramedullary pinning may be an appropriate treatment option for select distal femoral fractures in skeletally immature dogs; however, more rigid fixation methods should be considered when possible, to effectively counter rotational forces during fracture healing.

Parallel Reconstruction of Vascularized Fibula Autograft for Treatment of Complications after Resection of Malignant Tumor from the Thigh.

The authors herein introduce a modification of parallel reconstruction with a vascularized fibula autograft (VFA) for cases of femur allograft complications. Conventional parallel reconstruction, in which the fibula with its vascular pedicle is placed on the medial side of the femur and allogeneic bone, may be an effective means to solve the allograft complications. However, the limited contact area between the fibula and femur/allogeneic bone can affect the bone healing ability. Furthermore, the rigid internal fixation method for the VFA may cause stress shielding and result in bone resorption. The authors propose the use of modified parallel reconstruction of the VFA with fibula expansion and titanium cable fixation for patients with allograft-host junction nonunion, allogeneic bone fracture, and femoral shaft fracture after surgical removal of a malignant tumor from the thigh. The modified parallel reconstruction has been performed on 5 patients (2 patients underwent fibular expansion). All 5 patients with 7 nonunions of the allograft-host junction or fracture were followed up for 33.2 months. The length of fibular graft was 10 to 20 cm, with an average of 15.0 cm. The union rate of allograft-host junction and fracture was 100% (7 of 7), and the union time was 15.9 months. This modified parallel reconstruction technique can achieve satisfactory union in treatment of the above complications.

Finite element analysis of different internal fixation methods for the treatment of atrophic mandible fractures

The aim of this study is to evaluate different plate systems and contribute to revealing the most appropriate treatment option for severe atrophic edentulous mandible fractures. A total of 8 different types of rigid internal fixation methods, which were a 4-hole miniplate on the crest, a 4-hole miniplate on the basis, a 6-hole miniplate on the crest, a 6-hole miniplate on the basis, two 4-hole mini plates on both the crest and basis, two 6-hole mini plates on both crest and basis, a 6-hole reconstruction plate on the crest and a 6-hole reconstruction plate on the basis, were simulated. Stress analysis on plates and screws and the displacement between fragments were evaluated using finite element analysis. The lowest von Mises stress was observed on the basis plate in Group 6. The highest von Mises stresses were measured on the screws closes to the fracture line. Values exceeding the boundary conditions were observed only in Groups 3 and 4 under molar loading. The highest compressive stresses were measured in Group 1, and the lowest compressive stresses were measured in Group 6. Under molar loading, the highest displacement was observed in Group 3, and the lowest displacement was observed in Group 6. When all groups are evaluated in terms of stress distributions and stability, a 1.5 mm thick six-hole reconstruction plate can be a reliable method in the treatment of severe atrophic edentulous mandible fractures.

A novel technique for stabilising sacroiliac joint dislocation using spinal instrumentation: technical notes and clinical outcomes

PurposeCurrently, sacroiliac joint dislocations, including crescent fracture–dislocations, are treated using several techniques that have certain issues. We present the technical details and clinical outcomes of a new technique, anterior sacroiliac stabilisation (ASIS), performed using spinal instrumentation.MethodsASIS is performed with the patient in a supine position via the ilioinguinal approach. The displacements are reduced and fixed by inserting cancellous screws from the sacral ala and iliac brim; the screw heads are bridged using a rod and locked. We performed a retrospective review of patients with iliosacral disruption who underwent ASIS between May 2012 and December 2020 at two medical facilities. The patients were assessed for age, sex, injury type, associated injuries, complications, functional outcome by evaluating the Majeed pelvic score after excluding the sexual intercourse score and fracture union.ResultsWe enrolled 11 patients (median age: 63 years). The median operative time was 195 min, median blood loss was 570 g, and eight patients (72.3%) required blood transfusion. The sacral and iliac screws had a diameter of 6.0–8.0 mm and 6.2–8.0 mm, and a length of 50–70 mm and 40–80 mm, respectively. Bone union was achieved with no marked loss of reduction in the median follow-up period of 12 months in all cases. The median Majeed score at the final follow-up was 85/96.ConclusionASIS is a rigid internal fixation method that provides angular stability. Despite invasiveness issues compared to iliosacral screw fixation, this method is easy to confirm and achieves precise reduction.

Rigid Fixation after Intraoral Vertical Ramus Osteotomy: A Retrospective Study and Description of Technique

The intraoral vertical ramus osteotomy (IVRO) is an osteotomy utilized in oral and maxillofacial surgery to aid in correction of mandibular and facial deformities. Traditionally, performing this osteotomy requires a period of maxillomandibular fixation (MMF) following surgery, which can have effects on the teeth, temporomandibular joints, and patient satisfaction. Completion of the IVRO can be technically difficult due to poor visualization of the lateral mandible and variation in position of the inferior alveolar nerve. The authors' institution has successfully implemented rigid fixation of IVROs that removes the need for MMF following surgery. Seventy-seven patients underwent a total of 134 IVROs between 2017 and 2020 at the institution. Thirty-eight patients had rigid fixation for a total of 65 fixated IVROs. Among patients who underwent rigid fixation of IVRO, 3 experienced temporomandibular joint dysfunction and 2 experienced paresthesia in the V3 distribution. Of 69 IVROs without fixation, 2 patients experienced temporomandibular joint dysfunction and 1 patient had paresthesia in V3 distribution. Rigid fixation of IVROs was noted to add intraoperative time but did obviate the need for postoperative MMF in patients. In this study, the authors describe their institution's method for rigid fixation of IVRO. Additionally, the authors have developed a process for fabricating custom cutting guides to aid in IVRO completion. Utilization of the cutting guides allows for pre-surgical placement of the osteotomy and eliminates the need for direct visualization intraoperatively.

Lag Screws in Maxillofacial Trauma- A Review

The etiology of mandibular fractures includes mainly assaults and road traffic automobile accidents. Additionally, fall and sports injuries are the foremost common causes for mandibular fractures. Mandibular fractures outnumbered zygomatic and maxillary fractures by a ratio of 6:2:1, respectively. Road traffic accidents is that the most typical etiology, followed by assaults and sport-related injuries. For the management of maxillofacial trauma, the treatment commonly done is open reduction and Internal Fixation using miniplates. Lag screws as compared with plates, have a plus of the necessity of minimum implant material which they also provide maximum stability. The lag screw placement is a simple method of rigid fixation. The choice of the lag screw technique depends on patient factors, kind of fracture, site of fracture, and thus the skill of surgeon. The aim of this review is to assess the efficiency of Lag Screws for the management of maxillofacial trauma.

Effect of column root connections on the dynamic behavior of Chuandou-style timber structures

Chuandou-style timber structures have been widely deployed in rural areas of Southern China; however, their seismic performance has not been fully examined. A shaking table test for a half-scale two-story Chuandou-style timber structure filled with wooden walls was performed first. The slippage of the column root, pull-out of the tenon, and extrusion deformation between the wooden wall and the timber frame were the principal damage patterns. Then, a nonlinear dynamic analysis of a finite element (FE) model of the tested structure was performed, which was established based on a reasonable structural simplification using OpenSees. Two different types of connections between the column root and cornerstone were investigated in detail: hinged connection and rigid connection. The results indicate that the relative errors between the FE modeling and experiments in terms of the first structural natural frequency were 6.5% and 11.3% in the x and y directions, respectively. The rigid connection of the column root negatively affected the dynamic response of the Chuandou-style timber structure compared to the hinged connection. The acceleration amplification factors of each structural layer were greater than 1.0 when the column root was rigidly connected, and the inherent advantages of timber structures in terms of the energy dissipation capacity were seriously diminished. Therefore, the complete rigid fixation method is not recommended for the column root in Chuandou-style timber structures in engineering practice.

The Cat Mandible (II): Manipulation of the Jaw, with a New Prosthesis Proposal, to Avoid Iatrogenic Complications.

Simple SummaryThe small size of the feline mandible makes its manipulation difficult when fixing dislocations of the temporomandibular joint or mandibular fractures. In both cases, non-invasive techniques should be considered first. When not possible, fracture repair with internal fixation using bone plates would be the best option. Simple jaw fractures should be repaired first, and caudal to rostral. In addition, a ventral approach makes the bone fragments exposure and its manipulation easier. However, the cat mandible has little space to safely place the bone plate screws without damaging the tooth roots and/or the mandibular blood and nervous supply. As a consequence, we propose a conceptual model of a mandibular prosthesis that would provide biomechanical stabilization, avoiding any unintended (iatrogenic) damage to those structures. The improvement of imaging techniques and a patient-specific prosthesis made of full biocompatible material are part of the future trends to improve patients’ recovery.The cat mandible is relatively small, and its manipulation implies the use of fixing methods and different repair techniques according to its small size to keep its biomechanical functionality intact. Attempts to fix dislocations of the temporomandibular joint should be primarily performed by non-invasive techniques (repositioning the bones and immobilisation), although when this is not possible, a surgical method should be used. Regarding mandibular fractures, these are usually concurrent with other traumatic injuries that, if serious, should be treated first. A non-invasive approach should also first be considered to fix mandibular fractures. When this is impractical, internal rigid fixation methods, such as osteosynthesis plates, should be used. However, it should be taken into account that in the cat mandible, dental roots and the mandibular canal structures occupy most of the volume of the mandibular body, a fact that makes it challenging to apply a plate with fixed screw positions without invading dental roots or neurovascular structures. Therefore, we propose a new prosthesis design that will provide acceptable rigid biomechanical stabilisation, but avoid dental root and neurovascular damage, when fixing simple mandibular body fractures. Future trends will include the use of better diagnostic imaging techniques, a patient-specific prosthesis design and the use of more biocompatible materials to minimise the patient’s recovery period and suffering.

ПОСЛЕОПЕРАЦИОННАЯ РЕАБИЛИТАЦИЯ БОЛЬНЫХ С АНОМАЛИЯМИ РАЗВИТИЯ ЧЕЛЮСТЕЙ

The article discusses the results of research in the field of rehabilitation of postoperative patients with developmental anomalies of the dentition and deformities. The study was carried out on the basis of the Osh Interregional Joint Clinical Hospital in the Department of Maxillofacial Surgery. The study was conducted in 104 patients, of whom 42 were women and 62 were men. The study was carried out using the methods of stage-by-stage rehabilitation in the postoperative period, in addition to echo-osteometric examination of bone tissue. The model of postoperative rehabilitation of patients with lower and upper prognosis, which we used, including three stages, is based on the principle of creating optimal conditions for bone wound healing. As applied to patients with superior prognosis, it is achieved by the method of rigid fixation of osteotomized fragments using mini-plates and a bracket system with such an arrangement of fixing elements that form a quadrangular system of resistance forces that holds the displaced fragments in the achieved ratio.

Comparative Evaluation of 7 Fixation Plates in Mandibular Angle Fractures Using Finite Element Analysis

Background: The finite element method is a used computational technique in obtaining detailed displacement of the fractured mandible with a fixation system. Objectives: The aim of the study was the evaluation of the biomechanical performance of different rigid fixation methods in mandibular angle fractures. Methods: Computed Tomography (CT) scans applied to prepare a model of the mandible with a mandibular fracture angle. The fracture line was fixed with 7 different fixation plates. The CT scans were transferred and converted to the finite element model. The commercial ANSYS software was applied to analyze the Von Mises stresses and the amount of displacement on bones, plates, and screws. 150-newton vertical force was applied to central incisors in order to simulate the most critical loading. Results: The maximum Von Mises stress values were found in the Champy technique with 474 Mpa in bones and 579 Mpa in screws, whereas the lowest Von Mises stress values observed in the square plate which was 180 Mpa. The minimum displacement observed in the Reconstructive plate & mini-plate which was 0.25 millimeters. Conclusion: The application of Reconstructive Plate & Mini-Plate, Dual straight mini-plates, Square Mini-Plate led to lower stress and displacement than other techniques in the bone, Plate, and screw. Reconstructive Plate & Mini-Plate, Dual straight mini-plates, Square mini-plate offers more resistance and stability at the fracture site than other techniques used in the current study. This study was done based on the analysis of computer data. Clinical evidence showed that other procedures were used for many years with success. There are many other factors in the clinical application that have a critical role in stability.

Plantar plating the modified Lapidus arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: Modified Lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the 1C-MTT joint. Complications of this procedure include delayed union and non – union. To prevent them, several rigid fixation methods have been proposed. Biomechanically, plantar plate fixation may be the best solution. Therefore, we sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis using two different plantar plate fixation systems. Methods: After IRB approval, we reviewed our prospectively collected database for patients operated on with a modified Lapidus arthrodesis. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum FU of 1 yr and agreed to participate in the study. Patients with neuropathy, previous surgery, concomitant midfoot/hindfoot procedures or those which fixation method was different from a plantar plate were excluded. Preoperative and postoperative IM angle was evaluated. Two independent musculoskeletal radiologists assessed consolidation under CT scan at 12 weeks postop. Triaxial 2-mm reformatted CT slices were used to calculate joint fusion percentage. Each patient was assigned to a consolidation group considering joint fusion percentage: 0-24%, 25-50%, 51-74%, 75-100%. Intra/interobserver coefficients of variability were calculated. SF-36, SMFA, FAOS and FAAM were obtained preoperatively and at one year follow up. t-test was performed to address for functional outcomes differences in-between groups. Results: Twenty-three patients (35 feet) met inclusion criteria. Mean age was 47 years (13-65), 83% female and 17% male. Eleven patients had bilateral surgery. Mean preoperative/postoperative IM angle were 16+3 and 9+2, respectively (p<0.001). Ten feet achieved <24% consolidation (33%) and 20 feet >25% (67%). With the numbers available, consolidation rate didn´t differ in patients undergoing unilateral/bilateral surgery(p=1.0) or plating system(p=0.22). One patient had an anterior tibialis tendon rupture and 1 patient presented an infected non-union, prompting revision. Mean preoperative/postoperative values for SF-36 physical and mental component were 49 and 76(p<0.001); and 43 and 68(p<0.001), respectively. FAOS-pain were 60 and 81(p<0.001);FAOS-daily-life were 59 and 96(p<0.001);FAOS-sport were 43 and 74 (p<0.001);and FAAM-Daily-life score were 67 and 87(p<0.001). No significant differences were found for SMFA. Conclusion: Despite a low consolidation rate at 12 weeks post op, patients with plantar plated Lapidus arthrodesis presented a significant increase in functional outcomes and a low revision/complication rate at 1 yr FU. Consideration should be given to delay evaluation under CT scan to 24 weeks post op.

Interlocking Nail Combined with Locking Plate Fixation for a Distal Diaphysis Femur Comminuted Fracture in a Dog

Background: Interlocking Nail (ILN) is similar a solid intramedullary pins with screws or bolts passing through one and nail holes (locking effect). This implant mostly have been putted normograde, passing by trochanteric fossa of femur, although it is reported to be inserted through the knee, passing by fracture focus and ending close to proximal femur. It is carriedout especially when there is a comminuted fracture in distal third shaft of femur. Locking plate systems work as internal fixators with some advantages compared to conventional plates. It can be used combined with intramedullary pin, and is an effective technique for increase stifeness stabilization of comminuted long-bone fractures, especially for bending. Some studies reported the use of plate-nail to increase even more the stiffness of implants, because of locking screw in plate and nail. Based on the same propose, we aim to report a case of an ILNs normograde (from distal to proximal) connected to a locking plate in highly comminuted distal diaphyseal fracture since it is rarely report in veterinary medicine orthopaedics.Case: A 5-year-old male mixed breed dog was assessed and diagnosed a fracture of the femur in the right pelvic limb. On physical examination, the dog had nonweight bearing lameness in the affected limb and, mobility of the fragments was noted following digital pressure. A comminuted fracture of the distal diaphysis of the femur was identified. A lateral approach tothe shaft of the femur, the incision was extended to the stifle joint through a lateral incision because the fracture seemed to extend throughout the physis. Open but do not touch approach was performed and reduction was gotten without modified environment of fracture hematoma. A surgical drill was inserted through the access in distal extremity of the bone to openthe medullary cavity of the femur. After that, an interlocking nail was inserted into the opening into the distal fragment, the fracture was reduced and the nail was inserted towards the proximal end of the bone. At the next stage the nail was fitted into the medullary canal and it was locked relative to the main fragments of the femur using locking head screws that were anchored in the load carrier of the plate. Postoperative radiographic views documented appropriate implants location and satisfactory femur fracture alignment. At 3 weeks, the patient showed functional use of the limb with partial weight bearing.Discussion: A biomechanical study comparing plate-rod and plate-nail system in gap fractures, showed that maximum load was significant different between the groups, and in plate-nail it was always heavier, it occurs because of the nail bigger diameter and screws pass through nail holes. What prove that this system is stiffer than plate-rod, so because this patient has osteopenia and thin cortical bone like showed previously, we preferred to use nail than intramedullary pin. The ILN could be introduced from proximal to distal femur (antegrade or normograde) and passing through the knee (called in medicine by retrograde, although in veterinary medicine this way is called normograte too), it depends on bone conformation. Several studies used normograde via in femur from distal to proximal, especially in distal fracture. In this case, it was used this via, by the knee, because it would promote better bone stock to insert the screws, since the nail was putted as close as possible from articular surface. In conclusion, the case reported here documented that the combination of a normograde (from distal to proximal) interlock nail with a locking plate provides a rigid fixation method, promoting satisfactory functional recovery time. Further investigations should be performed using plate-nail in vivo to give to us more precise data.Keywords: biological osteosynthesis, canine, orthopaedics, retrograde nail.

Non-restricted weight-bearing after modified Lapidus arthrodesis

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

Assessment of Fixation of Mandibular Interforaminal Fractures by Using a Single Second-Generation Headless Compression Screw: A Pilot Study.

The aim of this article is to evaluate the efficacy of a single second-generation headless compression screw along with a lower arch bar in the fixation of interforaminal mandible fractures. A total of seven patients were included in the study. An open approach was used either intraorally or extraorally. A second-generation 3.0 HCS (headless compression screw), 24 to 32 mm in length, diameter at the head of 3.5 mm, smooth shaft with 2.0 mm and at the leading edge 3.0 mm (Synthes, Paoli, PA) was used for the fixation along with a lower arch bar. Postoperative clinical and radiographic follow-up was performed at 3 weeks, 3 months, 6 months, and 1 year. A single, cannulated HCS was found to be effective in fixation of interforaminal mandible fractures except in one case where a miniplate had to be applied subapically. Clinical and radiographic follow-up revealed accurate reduction and fixation in all cases and no postoperative occlusal disturbances. A single, second-generation HCS along with a lower arch bar provides good results when used for the fixation of interforaminal mandible fractures. Headless compression screw fixation of interforaminal mandible fracture is a simple, quick, economic, and efficient method of rigid fixation with minimum complications.

Evaluation of Three Different Osteosynthesis Methods for Mandibular Angle Fractures: Vertical Load Test.

The aim of this study was to evaluate the mechanical behavior of different rigid fixation methods in mandible angle fractures. Three different plates were tested: one 4-hole grid miniplate, one 8-hole curved grid miniplate, and one 4-hole straight miniplate.For the loading tests, 30 polyurethane hemimandibles sectioned at the angle area to simulate a simple angle fracture were used: 10 hemimandibles for each group. The mechanical evaluation revealed that the straight plate positioned at the tension zone presented the best results in supporting vertical loading in the predefined displacement moments of 1, 3, and 5 mm. Regarding the grid plates, there was no statistically significant difference between the smaller and the larger plate.According to this sample, the straight plate positioned in the tension zone presented better results than the other 2 different grid plates positioned at the neutral zone.

Management of Zygomatic Fractures: A National Survey.

Repair of zygomatic fractures can be classified into the early closed reduction or the more recent open reduction and rigid internal fixation (ORIF) methods. Surgical training and literature advocate ORIF, but the actual frequency of the different techniques in clinical practice is unknown. The purpose of this study was to determine the current trends in the management of zygomatic fractures among US surgeons and elucidate their influences. A 10-question survey was developed and distributed to over 16,000 practicing US facial trauma surgeons, including plastic surgeons (PS), oral and maxillofacial surgeons (OMFS), and otorhinolaryngologists (ENT). The survey queried training background, zygoma fracture treatment preferences, and rationale. Responses were tabulated and both univariate and bivariate statistical analyses completed. One thousand six hundred eleven (10%) total responses were received. Zygomatic fractures are treated most commonly by OMFS (61%), then PS (20%) and ENT (19%), with 71% of repairs being performed in private practice. Open reduction and rigid internal fixation is the most common treatment modality (81%), with most surgeons using 2 to 3 sites for exposure, reduction, and fixation with titanium miniplates (70%). Thirty-five percent of surgeons perform routine orbital floor exploration. Forty-three percent quoted training and 32% reported accuracy of repair as the primary reason for choosing ORIF. This is the largest reported survey on the repair of zygoma fractures. The response rate suggests dominance of OMFS in zygoma fracture care, an area pioneered by PS. Evolution of technique is also evident by predominance of ORIF with emphasis of multiple points of exposure, reduction, and fixation with rigid hardware.

Transoral Fixation of Bicortical Screws Is Safe and Feasible for Lower Jaw Osteotomies

Transoral placement of bicortical screws is a rigid fixation method in orthognathic surgery that is used less often than transbuccal placement. The aim of this study was to examine the postoperative outcome of transoral bicortical screw insertion during orthognathic surgery and to compare it with the more common transbuccal fixation technique. A retrospective cohort study was conducted. Clinical files of orthognathic surgery patients operated on from January 2010 through December 2012 were reviewed. Screw insertion approach (transoral vs transbuccal) was examined as a predictive variable for postoperative complications (hardware removal and infection). Type of surgery, fibrin sealant, preoperative third molar removal, and patient age and gender were analyzed as potential risk factors. Descriptive and bivariate statistics and regression analyses were performed. Of the 606 patients whose cases were reviewed, 509 patients (185 men; mean age, 26.3 ± 11.1yr) met the inclusion criteria. Most presented with a Class II malocclusion (84.5%). A transbuccal approach was used in 27.5% of cases, leading to a screw-related infection of 6.3%. Patients treated with a transoral technique (72.5%) had fewer infections (3.5%), but this was not statistically relevant. Screw removal was indicated in 3.3% of patients. Screw placement using the transoral and transbuccal approaches was performed in 3.0 and 4.2% of patients, respectively. Infection and screw removal rates did not differ significantly between fixation techniques (P= .16 and P= .49, respectively). The present findings showed an overall low rate of screw removal and infection secondary to bicortical screw insertion during orthognathic surgery. The postoperative outcome was similar for the transoral and transbuccal approaches.

Application of a Shape-Memory Alloy Concentrator in Displaced Patella Fractures: Technique and Long-Term Results

Operative treatment is usually recommended in displaced patella fractures. Several techniques have been advocated for internal fixation of patella fractures. Despite the relatively good clinical outcomes that have been demonstrated in many studies, postoperative morbidities such as fixation failure, nonunion, infection, and knee stiffness are not uncommon. We present a new alternative treatment technique for displaced patellar fractures. Between April 1995 and May 2005, we used the Nitinol Patella Concentrator (NTPC) to treat 156 consecutive patients with displaced patellar fractures. Injuries arose from vehicular accidents in 56 (35.9%) cases, direct falls onto the knee in 85 (54.5%) cases, and sports injuries in 15 (9.6%) cases. The mean patient age was 46.3 years (range, 25-77 years). Clinical assessments were made using the Böstman knee score and the MOS SF-36 questionnaire (Medical Outcomes Study 36-item short-form health survey), which were both recorded at the final follow-up visit. The mean follow-up was 7.3 years (range, 6-17 years). At the final follow-up, the Böstman knee scores were excellent in 88 cases (28-30), good in 55 (20-27), and unsatisfactory in 13 (<20). According to the MOS SF-36 evaluation, the average score was 84.5 (range, 62-91). Treatment of patellar fracture with the NTPC not only may serve as an effective and rigid fixation method in multifragmented displaced and inferior pole fractures, but also may provide continuous concentrative compression during the osseous healing process. Thus, use of the NTPC may help restore the functional integrity of the extensor mechanism and permit early rehabilitation with a lower incidence of postoperative complications.