Modified osteosynthesis for condylar neck fractures in atrophic mandibles

Function Impairment and Pain After Closed Treatment of Fractures of the Mandibular Condyle

BACKGROUND

To determine the prognosis of fractures of the mandibular condyle after closed treatment.

METHODS

Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on radiographs. Follow-up was after 12 months in which the average pain, experienced during the last week (visual analog scale, 100 mm), and mandibular functioning were assessed (mandibular function impairment questionnaire (MFIQ)).

RESULTS

Data of 116 (81%) patients, 41 women (35%) and 75 men (65%), were available for analysis. Condylar neck fractures were most common (52%). Bilateral fractures were present in 28% of the patients. Pain (visual analog scale score >0) was found in 9% of the patients. Impaired mandibular function was found in 40% (MFIQ >0) and 24% (MFIQ > or =4) of the patients. The most important risk factor for pain was being a woman. The most important risk factors for function impairment were > or =25 years of age and gross displacement of the fracture parts.

CONCLUSION

The overall prognosis of mandibular function and pain after closed treatment of condylar fractures is good. The most important risk factor for pain persisting for 1 year after closed treatment of a condylar fracture is being a woman. The most important risk factors for function impairment are an age of > or =25 years and gross displacement of the fracture parts.

An in vitro evaluation of miniplate fixation techniques for fractures of the atrophic edentulous mandible

This study was undertaken to evaluate the biomechanical stability of various miniplate fixation techniques in varying degrees of atrophy and to determine optimal fixation techniques for fractures of the atrophic edentulous mandible. A total of 78 bovine ribs were randomly divided into 13 groups of six each; one non-atrophic group and twelve atrophic groups. Each one of the 13 sets of six ribs was formed based on the vertical dimension (40, 20, 15 or 10 mm) and osteotomized. The segments so produced were then reduced and fixed using various miniplate fixation techniques. The stability of various miniplate fixations in ribs showing varying degrees of atrophy (10, 15 and 20 mm) was compared with that of one miniplate fixation in non-atrophic ribs (40 mm), used as a standard. Atrophic groups utilizing single miniplate were significantly less stable than the non-atrophic group, whereas atrophic groups fitted with double miniplates, such as two 4-hole or two 6-hole miniplates, were significantly more stable than the non-atrophic group. The two miniplate fixation technique is recommended for the provision of adequate fracture site stability when open reduction is indicated in cases of atrophic edentulous mandibular fractures.

Clinical and radiological evaluation following surgical treatment of condylar neck fractures with lag screws

It was the purpose of this study to evaluate the outcome of lag screw osteosynthesis in severely displaced fractures or fracture dislocations of the mandibular condyle as well as intra- and postoperative complications of this technique. From 1980 to 1996 a total of 492 patients with condylar fractures were treated with lag screw osteosynthesis. Clinical and radiological follow-ups were carried out in 230 patients with severely displaced fractures or fracture dislocations of the mandibular condyle. The period between surgery and follow-up was between 6 months and 2 years. The majority of the clinical results were satisfactory presumably due to the anatomically exact reduction of the fragment (93.4%). Extreme anatomic variations of the mandible (5.8%) and incorrect application of the technique (8.8%) resulted in reduced functional stability of lag screw osteosynthesis. Insufficient fragment reduction and postoperative complications (such as wound infection) entailed restriction of mandibular mobility and arthrotic deformations were seen as persistent radiological irregularities of the mandible. It has been possible to avoid complications and to achieve favourable functional results in complicated fractures of the mandibular condyle by applying strict indications for lag screw osteosynthesis and by considering the individual anatomical peculiarities.