Rigid Fixation Techniques Research Articles

Rationale and Endoscopic Technique for Anatomic Placement and Rigid Fixation of a Double-Looped Semitendinosus and Gracilis Graft

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print CollectionsFor Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor Permissions Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search

Comparison between the rigidity of bicortical screws and a miniplate for fixation of a mandibular setback after a simulated bilateral sagittal split osteotomy

Purpose: This investigation compared the biomechanical stability of three bicortical screws with that of a single four-hole miniplate after 5-mm mandibular setback after a bilateral sagittal split osteotomy (BSSO) in cadaver mandibles. Materials and Methods: Thirty human cadaver hemimandibles underwent BSSO followed by two different rigid fixation techniques. All specimens had no third molar, bony pathology, or evidence of mandibular fracture, and there was no history of renal disease or hyperparathyroidism. The specimens were randomly divided into two groups. In group I, three bicortical screws were placed at the superior border, and in group II, one four-hole miniplate was secured on the external oblique ridge with four monocortical screws. The bony height of the mandible was recorded. Maximum resistance load (MRL), the greatest load recorded just before a sudden decrease in load level (bone or fixation failure), was recorded when the mandibles were tested in a compression machine. Multiple regression analysis was used to evaluate the differences in bone height and the MRL between groups I and II. Results: The mean bone height in groups I and II were 28.64 ± 2.50 mm and 28.72 ± 4.08 mm, respectively. The mean MRL in group I (20.49 ± 7.22 kg) was greater than in group II (17.41 ± 7.81 kg). The multiple regression analysis showed no significant difference in the bone height and the MRL between group I and group II (beta = 2.3492, P = .4114). Conclusion: There was no statistically significant difference in stability provided the two techniques.

Fixation of the craniofacial skeleton with butyl-2-cyanoacrylate and its effects on histotoxicity and healing.

Butyl-2-cyanoacrylate is an easily applied, biocompatible, bioresorbable polymer glue that provides an alternative to conventional rigid fixation techniques. Our aim was to determine if cyanoacrylate fixation of the bone flap in a rabbit craniotomy model provides the healing and strength afforded by plate and screw fixation. We also investigated the inflammatory responses of adjacent tissues including the scalp, cranium, and brain. A unilateral parietal bone flap was elevated in 33 adult New Zealand rabbits. The bone was fixed in position with cyanoacrylate (n = 13), fixed with a microplate and screws (n = 14), or was replaced without fixation (sham-control, n = 6). Normal scar formation and no residual polymer were found in scalp specimens. Neuropathologic analysis identified the presence of residual polymer on the surface of 2 of the 13 rabbit brains. Histopathologic analysis of the bone flap-to-skull interface revealed no difference in the degree but rather in the quality of inflammation and healing between the plate and screw and polymer fixation groups. Microdensitometric analysis of the bone gap revealed nearly equivalent bone density in the cyanoacrylate and plated groups, tending to less density in the sham group (p = 0.11 and 0.09, respectively). An additional study focusing on neurotoxicity was performed in 20 adult rabbits with 3-week and 11-week recovery periods and similarly found the absence of a marked inflammatory response to the polymer. In conclusion, bone healing and soft-tissue inflammation were comparable between cyanoacrylate and plate and screw fixation groups. Although butyl-2-cyanoacrylate glue fixation may provide a reasonable alternative to hardware fixation, further investigations are necessary to identify its ideal utilization.

Distraction osteogenesis and its application to the midface and bony orbit in craniosynostosis syndromes.

The purpose of this study was to demonstrate the potential advantages of applying distraction osteogenesis techniques to the correction of orbital and midfacial hypoplasia in craniosynostosis syndromes. Fifteen children with various craniosynostosis syndromes underwent Le Fort III advancement assisted by gradual distraction utilizing a pair of internal distraction devices custom-fabricated for each child. The surgical procedure consisted of a Le Fort III osteotomy, implantation of internal devices with initiation of distraction intraoperatively, and an accelerated rate of midfacial advancement over the next 3 to 5 days. Activation of the distraction hardware was accomplished by a percutaneous pin, which was removed at the end of the distraction protocol, allowing the internal devices to fixate the fragment for a minimum of 6 months during the period of consolidation. With follow-up ranging between 3 to 38 months, the average orbital and midfacial advancement was 19.7 mm (range, 12.0-30.0 mm). Proptosis was lessened and facial proportions significantly improved in all patients. Serious complications were not encountered. The modified distraction protocol utilized in this group of patients was aimed at addressing the unique requirements of pediatric craniofacial surgery, and resulted in almost twice the amount of correction previously reported for traditional rigid fixation techniques.

Internal fixation of maxillofacial fractures: indications and current implant technologies and materials.

Rigid fixation techniques are frequently utilized for the repair of maxillofacial skeletal injuries. This paper reviews the commonly available implants and materials along with their typical indications. The focus is primarily on the most recent trends and developments. Latticework plates and meshes provide greater fixation strength with smaller amounts of metal; modern reconstruction plates allow for fixation of the screws directly to the plates; self-drilling screws make application faster and easier. Resorbable implants made of various polyester polymers are now available, though their indications remain limited thus far. Future developments are discussed as well, including the advent of endoscopic plate placement and image-guided skeletal repositioning.

Pediatric mandibular fractures.

Over the last 20 years, a revolution in the management of facial fractures has taken place. Refinements in biocompatible materials of great delicacy and strength along with advances in our understanding of biomechanics of the face, have rendered complex injuries consistently amenable to accurate 3-dimensional reconstruction. Furthermore, with the availability of education in the techniques of internal rigid fixation, these advanced techniques have become routine practice in adults. However, the suitability of rigid internal fixation for children remains controversial. There are many concerns about the effect of implanted hardware in the mandible of a growing child. In addition, some evidence suggests that the elevation of functional matrix off of bone may result in alterations in development. The goal is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. However, in children the treatment of bony injuries is most easily accomplished by techniques that may adversely effect craniofacial development. While it is not entirely possible to resolve this dilemma, there exists an extensive body of experimental and clinical information on the appropriate management of pediatric mandibular fractures which can be used to formulate a rational treatment plan for most cases. This paper presents an overview of the contemporary understanding and application of these treatment principles.

Reasons for removal of rigid internal fixation devices in craniofacial surgery.

Despite the widespread use of rigid fixation techniques in craniofacial surgery, there is a paucity of studies in the literature that serve to better define the reasons for the subsequent removal of plates and screws. The current study appears to be the first to attempt to assess these issues among a broad range of craniofacial surgery patients. Fifty-five patients who underwent hardware removal following craniofacial surgery at the University of Michigan Medical Center between 1989 and 1995 were retrospectively studied via an in-depth chart review. Common reasons for hardware removal included palpable/prominent hardware in 19 patients (34.5%), loosening of plates and screws in 14 patients (25.5%), pain in 14 patients (25.5%), infection in 13 patients (23.6%), wound dehiscence/exposure of hardware in 11 patients (20%), and removal at the time of secondary procedures in 5 patients (9.1%). It is hoped that this study will serve as a tool to define more completely the risk of needing subsequent hardware removal among craniofacial surgery patients treated with rigid internal fixation.

Open reduction and internal fixation of acute mandibular fractures in adults.

The mandible is often fractured during maxillofacial trauma because of its prominence within the facial skeleton and the fact that it is a favorite target in interpersonal violence. Treatment of mandibular fractures has made significant advances over the years due to the study of biomechanical principles, advancements in biomaterials and instrumentation and scientifically based research of treatment outcomes. This article will review the principles and philosophy of AO/ASIF techniques as applied to treatment of mandible fractures. Representative cases of different mandible fractures and their treatment will reinforce the clinical application of rigid fixation techniques.

Wrist arthrodesis for failed wrist implant arthroplasty

Thirteen wrist arthrodeses were performed for failed wrist implant arthroplasties between 1984 and 1992. Twelve patients were available for review, with an average follow-up period of 28 months. The original arthroplasties consisted of 8 silicone implants and 4 metal-plastic total wrist implants. The surgical method involved a tricortical iliac bone graft and an intramedullary Steinmann pin. There were 7 excellent results, 4 good results, and 1 poor result. All but 1 patient had markedly improved function with no or mild pain. Seven patients had solid fusions and 5 patients had pseudarthroses. Four pseudarthroses occurred at the graft-metacarpal junction and 1 occurred at the graft-radius junction. Each patient with a solid fusion had an excellent result. All graft-metacarpal pseudarthroses were painless and did not limit the patients' activities. There were 17 complications in 9 patients. Wrist arthrodesis can be a successful salvage procedure for failed wrist implant arthroplasty in patients with rheumatoid arthritis. However, the complication rate can be high. Owing to the high incidence of distal graft-metacarpal pseudarthrosis, we recommend using more rigid fixation techniques in patients with failed wrist arthroplasties.

A comparison of skeletal stability after mandibular advancement and use of two rigid internal fixation techniques

A comparison of skeletal stability after mandibular advancement and use of two rigid internal fixation techniques

A comparison of skeletal stability after mandibular advancement and use of two rigid internal fixation techniques

Purpose : Two different methods of rigid fixation were compared for postoperative stability 6 months after mandibular advancement for treatment of Class II malocclusion. Material and Methods : Sixty (30 + 30) patients from two different oral and maxillofacial units treated for a Class II malocclusion by bilateral saggital split osteotomy (BSSO), and two different methods of internal rigid fixation were prospectively investigated. Two groups (S1, n = 15; S2, n = 15) had bicortical noncompressive screws inserted in the gonial area through a transcutaneous approach, and the other two groups (P1, n = 15; P2, n = 15) had the bone segments fixed with unicortical screws and miniplates on the lateral surface of the mandibular body. Cephalograms were taken preoperatively, 2 days postoperatively and 6 months after the operation. A computer program was used to superimpose the three cephalograms and to register the mandibular advancement and postoperative change both sagittally and vertically. Results : These were minor differences in the advancement and postoperative changes between the four groups, but statistically no significant difference was shown in either sagittal or vertical directions. However, statistically verified differences proved that increasing age was associated with a smaller amount of postsurgical relapse. Low-angle cases (ML/NSL <25 °) had a bigger amount of surgical ( P = .0008) and postsurgical ( P = .0195) movement compared with the patients in the high-angle group (ML/NSL <38 °). Using a multiple regression test, a positive correlation was also shown between the amount of surgical advancement and the amount of postsurgical instability ( P = .018). Conclusion : This prospective dual-center study indicates that the two different methods of internal rigid fixation after surgical advancement of the mandible by BSSO did not significantly differ from each other, and it is up to the individual operator to choose the method for internal rigid fixation.

Stabilization of an inserted tricalcium phosphate spacer enhances the healing of a segmental tibial defect in sheep.

The effect of inserting a tricalcium phosphate (TCP) spacer stabilized by a rigid or non-rigid fixation technique on the healing of segmental tibial defects of critical size was established. The osteotomized tibiae, 11 with and 8 without TCP spacers, were fixed by an external circular device in 11 mature sheep and by plates in 8 mature sheep, respectively. Healing was evaluated roentgenographically 16 weeks after the operation. Compared with the defects without TCP spacers, enhanced stability and healing were observed in the defects with TCP spacers under an identical external fixation. Furthermore, a significantly higher incidence of healing was obtained with plate fixation than with external device fixation in the TCP-implanted defects (P < 0.04). An abundant bridging callus was roentgenograpically demonstrated in most of the healed defects, but none in the unhealed defects. The TCP spacer with its mechanical integrity enhances the stability of external fixation, and the stable immobilization provided by rigid fixation is essential for osteoconduction of an inserted TCP spacer in the healing of segmental diaphyseal defects in sheep.

Management of patella fractures associated with central third bone-patella tendon-bone autograft ACL reconstructions.

Patella fractures are an acknowledged complication of cruciate ligament reconstructions that use bone-tendon-bone autografts. Two fracture patterns are seen: a nondisplaced longitudinal patellar fissure fracture recognized interoperatively and the classic displaced transverse fracture that disrupts the extensor mechanism. Rigid fixation techniques are described for each fracture type that minimally affect rehabilitative efforts.

Surgical model to assess the effects and optimal timing of craniofacial fixation.

An in utero swine model of craniofacial deformity was developed as a potential alternative to neonatal models currently used for evaluating the optimal timing and long-term effects of rigid fixation techniques on a growing cranium. At 75% gestation, seven fetal piglets were randomly selected to undergo periosteal stripping of frontal and parietal bone segments with and without extensive coronal suture fusion procedures with cyanoacrylate adhesive. Fetal swine were killed postpartum at 4 and 11 weeks after fusion to assess craniofacial deformity. Piglets undergoing coronal fusion had slight deviation of the nose-snout toward the side of fusion and taller cranial vaults. The vertical cranial index of the experimental fusion group was 0.34 in comparison to a vertical index of 0.27 for the controls, suggesting abnormal vertical height expansion. There was no difference in the horizontal cranial index of either control or experimental fusion groups. Neither sows nor piglets were lost to anesthetic complications, uterine sepsis, or preterm labor during the initial laparotomy or subsequent cesarean delivery.

A modified technique to determine the desired length of bicortical screws in sagittal split osteotomies

Since the original description of the bilateral sagittal split osteotomy (BSSO) by Obwegeser, several techniques have been described to avoid maxillomandibular fixation. These techniques of rigid internal fixation include use of lag screws,’ position screws,’ and miniplates.” Since 1988, the self-tapping position screw technique has been used in our institute for internal fixation of the BSS0.4 Until April 1995, 970 patients (1,935 sites) have been treated accordingly. However, in 8 patients, loosening of the screws occurred in the first postoperative week, which resulted in occlusal discrepancy and required reoperation. Loosening of the screws can be explained by apposition of the proximal and distal fragments under tension, a thin medial cortical bone layer, or use of short screws. To prevent the last, the use of commercially available depth-measuring devices is advocated. Another method to measure the length of the position screws in a rapid and accurate fashion is presented.

Endodontic sequelae of miniplate bone fixation

Various techniques of rigid internal fixation have evolved to achieve skeletal stability during healing. Although the miniplates and screws currently used have many advantages, their placement and presence may present significant difficulties for clinicians subsequently providing treatment. Problems with both endodontic diagnosis and treatment after miniplate fixation are illustrated with three case reports.

Simple Intermaxillary Fixation for Maxillomandibular Osteosynthesis

A simple intermaxillary fixation technique for the maxillomandibular osteosynthesis is devised using miniscrews and surgical wires. Using this technique, we have treated 13 cases of maxillomandibular fractures and osteotomies. Sufficient intermaxillary fixation was provided at surgery, and satisfactory results were obtained in all patients. This technique is quite simple and easy to use and requires no special instruments. Positive occlusion during surgery is obtained for the osteosynthesis, providing a very useful auxiliary technique for rigid internal fixation. The details of this technique are described.

RATIONALE FOR AESTHETIC SURGERY IN CONJUNCTION WITH ORTHOGNATHIC SURGERY

SUMMARY As experience and skill increase in the performance of orthognathic surgery in patients with skeletal-facial deformities, criteria for successful outcomes have become more rigid, with aesthetic outcomes being judged as critically as functional outcomes. Although skeletal procedures have long been planned to optimize aesthetics as well as function, increasing consideration is being given to performing adjunctive aesthetic surgical procedures before, during, or after orthognathic surgery to enhance aesthetic outcomes. This trend has been catalyzed by the development of rigid internal fixation techniques that have added stability to orthognathic surgical results and have been facilitated by the development of computer video-imaging. Computer video-imaging provides a means for simulating aesthetic changes, and rigid internal fixation makes combined therapy technically possible. Regarding optimal timing and sequencing of procedures, many variables must be considered in formulating a comprehensive treatment plan. These variables have been discussed with particular attention to their impact on the decision-making process in an attempt to establish a clinically useful rationale for planning aesthetic surgical procedures before, during, and after orthognathic surgery.

Atlas of Craniomaxillofacial Fixation

This volume is the most complete and user-friendly surgical atlas on rigid fixation techniques for the bones of the face and skull. It provides step-by-step guidance on the latest rigid fixation techniques for all types of craniomaxillofacial skeletal surgery, including trauma surgery, oncologic surgery, and orthognathic and craniofacial surgery. The book is designed to enable the surgeon to look up a specific technique and quickly find it displayed concisely and clearly, with a minimum of text and with outstanding illustrations depicting each step. Coverage begins with well-illustrated chapters on instrumentation and implants, principles and biomechanics of rigid fixation, principles and techniques of screw placement, surgical approaches to the face, and techniques for harvesting and preparing calvarial, rib, and iliac crest bone grafts. The remainder of the book presents fixation techniques for fractures of each anatomic region of the face and for orthognathic and craniofacial surgery fixations after various osteotomies. Cross-references listed after each technique guide readers to information elsewhere in the book on relevant principles and ancillary techniques

Rigid fixation of malar fractures

The zygoma, or bone, is an aesthetically important prominence within the overall structure of the face. It is a ready target for both intentional and accidental trauma. Optimal repair of injuries involving the malar requires precise open fracture reduction and placement of rigid internal fixation devices through concealed incisions. Surgical approaches to the complex and techniques of reduction and rigid fixation of injuries are presented.