Clinical aspects of a 2.0-mm locking plate system for mandibular fracture surgery

Comparative Evaluation of Masticatory Bite Force in Mandible Fractures Treated with Three-Dimensional Curved Locking Strut Plate Versus Straight Locking Miniplate

Aims and Objectives

To compare the efficacy of titanium 2.0-mm curved locking strut plate and 2.0-mm straight locking miniplate with regard to their intraoperative use and the stability of fixation achieved both, clinically and radiographically.

Materials and Methods

Forty patients with 62 sites of mandibular fractures requiring open reduction and internal fixation were included in the study. The sample was divided into two groups of twenty patients each depending upon whether patient received three-dimensional 2.0-mm locking curved strut plate (group A) or 2.0-mm straight locking miniplates (group B). Mouth opening, teeth in the fracture line, degree of displacement, time taken, neurosensory and bite force evaluation were done preoperatively, 1st, 7th day, 2nd week, 4th week, 6th week and 12th week postoperatively.

Results

Positive correlation was found between preoperative and postoperative bite force values at subsequent follow-up weeks. At 3rd month evaluation, the change in bite force from the previous follow-up visit was significantly greater in group A (locking strut plate) than group B (locking miniplate) in the incisor, left molar and right molar region. Statistically significant difference was observed between the two groups regarding time taken (P < 0.016) depicting less time taken for placement of three-dimensional 2.0-mm locking curved strut plate(group A) 20.30 ± 4.85 min as compared to 27.30 ± 6.82 min for fixation with 2.0 mm straight locking miniplates in group B.

Conclusion

The findings were suggestive that the both systems had better adaptation during fixation, comparable radiographic reduction and increased stability in postoperative period. However, 3D locking strut plate took relatively lesser operative time, offered good rigidity and better stabilization of fractured segments in three dimensions along with significant improvement in the masticatory bite force postoperatively.

Locking versus non-locking plating system in the treatment of mandibular fractures: A randomized comparative study

To evaluate fracture stability and complications such as infections, need for hardware removal, malunion, and nonunion when using 2.0-mm locking plating system in fixation of mandible fractures and to compare these to those associated with the 2.0-mm non-locking plating system. A prospective clinical study was conducted in a cohort of mandible fracture patients who were randomly assigned to two groups. Patients in the non-locking group were treated with 2.0-mm non-locking plating system, and those in locking group were treated with 2.0-mm locking plating system. Fracture stability, need for maxillomandibular fixation (MMF) and postoperative complications were assessed and compared. A total of 60 patients (30 in each group) were recruited. Significant differences were found between the two groups with respect to postoperative fracture stability (P = 0.001) and need for MMF (P = 0.005). Multivariate analysis revealed that type of fixation was not the only dependent variable which affected fracture stability. There were no significant differences in postoperative complications between the two groups. The 2.0-mm locking plating system provides greater stability and early functional restoration than the 2.0-mm non-locking plating system, with similar rates of postoperative complications. Thus, it can be used as a reliable and effective treatment modality for treating mandibular fractures.

Cortical lag screw fixation for the management of mandibular injuries

Objectives

Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites.

Materials and Methods

This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05.

Results

Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035).

Conclusion

We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.

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

PURPOSE

There is still no definitive consensus about the ideal technique in the treatment of anterior mandibular fractures. Therefore, this study aimed to determine clinical and radiographic outcomes of four different internal fixation devices used for this type of fractures.

METHODS

This was a cohort study that included 64 fracture cases. Fractures were fixed using four types of open reduction internal fixation devices: single 2.0-mm mini-locking plates, double 2.0-mm miniplates, double lag screw and double microplates. Investigated variables were surgical duration, wound dehiscence, infection, occlusion, mouth opening, patient compliance, nerve damage and postoperative oedema.

RESULTS

Male patients constituted 90.6% of the study sample. A proportion of 33% of the fractures were single symphysis and 67% were parasymphysis fractures. The most time-saving technique was the lag screw followed by microplate with mean/SD of 50.65 ± 4.152 min. Wound dehiscence occurred in 4.7% and 3.1% of the miniplate and the mini-locking groups respectively. Miniplate and microplate groups had small interfragmentary space at 1-month postoperative radiographs, while mini-locking and lag screw groups had no extra-callus formation.

CONCLUSION

The double lag screw and the single mini-locking plate are the most effective devices for primary bone healing of displaced mandibular symphysis/parasymphysis fractures which is attributed to their enhanced stability. Miniplates and microplates gave functionally well-balanced fixation and were also associated with higher patient convenience due to improved adaptability and relatively lower cost than locking plates. Cost-effectiveness of lag screws in comparison to bone plates is particularly beneficial in low-income countries.

Locking Miniplate Osteosynthesis of Anterior Mandibular Fractures-Quo Vadis?

PURPOSE

This study compared the clinical stability and efficacy of locking miniplates with those of standard miniplates in the osteosynthesis of anterior mandibular fractures using bite force recordings and other clinical parameters.

MATERIALS AND METHODS

A prospective randomized double-blinded clinical trial was carried out in patients from various hospitals of Hassan (India). Patients were randomly divided into 2 groups of locking (test) and standard (control) miniplate osteosynthesis. Bite force measurements were performed preoperatively and postoperatively at weekly intervals for 6 weeks using a bite force recorder. As a secondary outcome, patients also were assessed for other clinical parameters that might interfere with successful osteosynthesis at the fracture site. Appropriate statistical testing for intra- and intergroup measurements was carried out.

RESULTS

Forty-eight men 28 ± 12.3 years old met the inclusion criteria (24 patients in each group). A statistically significant difference (P < .05) was found in the incisor bite force between the 2 groups, with values in the locking group exceeding those in the standard group at postoperative weeks 2 and 5. Duration of surgery was shorter in the locking group (P = .015). No relevant difference was found for the other clinical parameters.

CONCLUSIONS

Bite force statistically increased at progressive follow-up visits compared with the preoperative recording in the locking group. Bite force recordings of patients treated with locking plates were higher and statistically relevant compared with those of patients treated with standard miniplates at the incisor region at postoperative weeks 2 and 5. The clinical outcomes of the 2 miniplate systems in the present study were similar; however, the locking miniplates required a relatively shorter operating time, produced less trauma to the periosteum and soft tissues with less hardware, and can be used as a "1-plate-for-all" system.

Comparison of 3D plate and locking plate in treatment of mandibular fracture-a clinical study

INTRODUCTION

This study was performed to evaluate the efficacy and post-operative complication of 3-dimensional (3D) titanium miniplate and locking plate in mandibular fractures (parasymphysis, symphysis, body, and angle).

MATERIALS AND METHODS

Forty patients, with non-comminuted mandibular fractures treated with open reduction and internal fixation using 3D titanium miniplate system or locking plate system through an intra-oral approach, were included in this study. All patients were systematically monitored up to 2 months post-operatively. Parameters recorded were infection, occlusal discrepancies, hardware failure, wound dehiscence, sensory disturbance of the inferior alveolar nerve, and stability of fractured segments.

RESULTS

Forty patients with mandibular fracture were divided into two groups randomly without any bias. The fractures of all 40 patients were found to be adequately fixed when checked intra-operatively after fixation. One patient (2.5%) of the 3D plate group developed an infection on the first and second post-operative visit and was treated by antibiotic coverage. One patient in the locking plate group (2.5%) reported wound dehiscence after the first week follow-up.

CONCLUSION

Both 3D titanium miniplates and locking plate are effective in the treatment of mandibular fractures, and overall complication rates are lesser. However, the 3D plating system uses less hardware in cases of parasymphysis and symphysis fractures and more hardware in cases of body and angle fractures.

Comparison of a 2.0-mm locking system with conventional 2.0- and 2.4-mm systems in the treatment of mandibular fractures: a randomized controlled trial

PURPOSE

A comparative study of the use of the 2.0-mm locking fixation system with conventional systems in the treatment of mandibular fractures was performed.

METHODS

For this study, 87 consecutive patients with 112 mandibular fractures were randomized to receive either 2.0-mm locking plates (n = 45) or conventional 2.0- or 2.4-mm plates (n = 42) and had a minimum follow-up of 6 months. Fractures were classified based on the degree of displacement and complexity. Statistical analyses were used to verify possible differences between the groups when separately compared unfavourable and favourable cases (p ≤ 0.050).

RESULTS

Despite randomization, systemic diseases were more frequent in the 2.0-mm locking group in favourable cases. Substance abuse occurred predominantly in the 2.0-mm locking group, in unfavourable and favourable fractures. There were more cases of complex fractures in the conventional group in unfavourable cases. One case involving a major postoperative complication occurred in the locking group (2.2%) and three cases occurred in the conventional group (7.1%) but with no significant difference between groups. In this study, there were no major differences between conventional and locking 2.0-mm locking systems with regard to the outcome of treated mandibular fractures, showing that both are adequate as long as the criteria of their indication and requirements for installation are met.

CONCLUSIONS

It was concluded that the 2.0-mm locking fixation system can replace conventional systems in the treatment of mandibular fractures; in addition, this approach was effective in the treatment of unfavourable fractures that typically require the 2.4-mm conventional system.

Retrospective study of mandibular angle fractures treated with three different fixation systems

Aim:

To evaluate the outcomes of mandibular angle fractures treated with metal 2.0 mm locking, metal 2.0 mm nonlocking, and 2.5 mm resorbable systems.

Study Design:

Retrospective cohort study.

Materials and Methods:

Trauma records were screened for linear angle fractures treated with open-reduction and internal semi-rigid fixation with single metal/bioresorbable plates, and baseline variables were tabulated. The outcome variable was the presence or absence of any complication.

Statistical Analysis Used:

The Fisher's exact test and analysis of covariance (ANCOVA) using STATA 11.

Results:

A total of 60 case records of over four years were included. The mean age of the patients was 27.4 (SD 9.7) years. Fifty-five were male and five female. There were 20 nonlocking and 16 locking metal miniplates and 24 bioresorbable plates. In 55 (91.6%) cases there was a third molar in the fracture line. In 51/55 (92.7%) cases the third molar was retained. In seven patients postoperative complications were seen. There was no difference between the complication rates of the three treatment groups. Infection was the most common complication followed by delayed union and hardware failure.

Conclusions:

This retrospective study found no difference in the complication rate when fractures of the mandibular angle were treated with locking or nonlocking miniplates or bioresorbable plates.

A meta-analysis comparing the 2.0-mm locking plate system with the 2.0-mm nonlocking plate system in treatment of mandible fractures

PURPOSE

The purpose of this meta-analysis was to evaluate the efficacy of the 2.0-mm locking miniplate/screw system in comparison with the 2.0-mm nonlocking miniplate/screw system in treatment of mandible fractures.

METHODS

Articles published until March 2013 were searched in the PubMed and EMBASE electronic databases. Eligible studies were restricted to comparative controlled trials.

RESULTS

Four studies with 220 patients and 420 fracture sites were enrolled into the analysis. The results showed that there were no significant differences in overall complications (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.24-1.36; P = 0.21), postoperative infection (OR, 0.43; 95% CI, 0.13-1.41, P = 0.17), and postoperative pain (P > 0.05) when comparing 2.0-mm locking miniplates with 2.0-mm nonlocking miniplates in treating mandible fractures. However, the use of 2.0-mm locking miniplates had a lower postoperative maxillomandibular fixation (MMF) rate than the use of 2.0-mm nonlocking miniplates (OR, 0.18; 95% CI, 0.08-0.41; P < 0.0001).

CONCLUSIONS

Mandible fractures treated with 2.0-mm locking miniplates and nonlocking 2.0-mm miniplates present similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using 2.0-mm locking miniplates also indicates that the 2.0-mm locking miniplate has a promising application in treatment of mandibular fractures.

Comparison of compressive strength between three different plates for mandibular angle fractures fixation

The present study aims to compare three types of internal fixation for fractures of the mandibular angle. Mechanical testing was performed on replicas of polyurethane hemimandibles sectioned at the angle region to simulate a fracture and fixed with three different hardwares. Fixation devices enrolled on this survey included the grid plates with and without an intermediate bar and the method described by Champy and colleagues in 1978 and the sample consisted of 10 hemimandibles for each group. Vertical loadings were applied on each hemimandible and recorded after a vertical displacement of 3 and 5 mm. Statistical analysis was made by means of the variance analysis (ANOVA) and the Duncan test with a significance level of 5%. The Champy technique showed a statistically significant increased resistance when compared to the grid plates after vertical displacements of 3 and 5 mm. The results of this survey suggest that the Champy technique, when compared to the grid plate positioned at the middle of the mandibular bone (placement site selected for this study), is more resistant than the grid plate and that the inclusion or not of an intermediate bar to the grid plates does not improve its resistance after linear vertical loadings.

The role of the titanium functionally dynamic bridging plate for the treatment of the atrophic mandible fractures

The role of the titanium functionally dynamic bridging plate (TFDBP) in the fracture treatment of the severely atrophic mandible was assessed retrospectively. In 28 consecutive patients with fractures of a severely atrophic mandible fixation was carried out with TFDBPs. Twenty-one patients with 27 fractures were included in the study and then followed up for complications and the progress of fracture healing for 17 months postoperatively on average. There was only one case that required plate removal. All patients showed bone healing 3 months after surgery. The mental nerve sensation improved in 12 out of 23 fractures that had presented with nerve function disturbance. Every patient who had dentures prior to sustaining the fracture was able to return to denture wearing 3 weeks after surgery. No major complications occurred. A high proportion of bone healing with a low complication rate was observed with the use of TFDBPs in the treatment of severely atrophic mandible fractures. The TFDBP is an excellent alternative to conventional plating of the severely atrophic mandible.

Efficacy of locking plates/screw system in mandibular fracture surgery

PURPOSE

The purpose of this study was to determine the efficiency of locking plates and screw system in the treatment of mandibular fracture surgery, by comparing them with the conventional system.

PATIENTS AND METHODS

A protocol for selection of patients with mandibular fractures was developed. One hundred patients were treated by locking plates and screw system and another 100 patients were treated with the conventional system. The patients were prospectively evaluated for the duration of surgery, difficulties encountered during surgery, neurologic changes, postsurgical occlusal relationship, adequacy of reduction and postsurgical complications. Data were compared for statistical significance with Chi-square test and Z-test.

RESULTS

There was statistically significant difference in postoperative infection, postoperative occlusal discrepancy, postoperative plate fracture and postoperative screw loosening and mobility of the fractured fragments and also the working time between the two systems.

CONCLUSION

The results of the present study are comparable with other published data and support the notion that the locking miniplate system is a valid alternative to conventional miniplates with several advantages, the only drawback being the additional working time required during adaptation of this hardware.