Is Open Reduction Internal Fixation Using Titanium Plates in the Mandible as Successful as We Think?

Abstract

Titanium plats are the gold-standard for fracture fixation. Titanium is considered biocompatible, corrosion resistant with an elasticity-modulus closest to bone. Nonetheless, titanium plates are not always as inherent as hoped. The authors investigated morbidity associated with titanium plates in mandibular fractures. A retrospective study of mandibular fractures treated between 2000 and 2018 using internal-fixation was conducted. Data included age, gender, complications, and location. Predictor-variable was location. Outcome-variable was plate removal. A total of 571 patients were included, 107 resulted in plate removal (18.7%). Body was the most prevalent location of fracture (29.3%). Symphysis/para-symphysis showed the highest removal rate (24.1%), followed by body and angle (21.3/19.8%). A total of 23.4% of double-plating cases resulted in plate removal, upper-border in 15% and lower-border in 8.8%, all reconstruction-plates. Exposure was the most frequent complication leading to removal. Although titanium plates are the gold standard, almost every fifth patient returns for plate removal. Agedistribution emphasizing 41 to 50 with decrease towards extremities may imply better healing in the young and soft-tissue elasticity and less complaints in the elderly. Significantly more complications in doubleplating compared to lower border suggests proximity to the oral-cavity as a risk-factor for removal. Complication rates and patterns are not negligible and perhaps should encourage clinicians to consider using biodegradable-systems for upper-border plates.

Deep circumflex iliac artery flap reconstruction in Brown’s Class I defect of mandible using a three-component surgical template system

“…38 However, in our experience, the application of double-layered miniplates described here is more appropriate for subtype I and II defects than a single reconstruction plate for the following reasons: (1) the stability and strength of miniplates was sufficient for a single-segment bone flap 39 ; (2) compared with reconstruction plates, miniplates provided better congruence between the bone and plate, resulting in more satisfactory facial symmetry; (3) coupled with the 3-STS system, the miniplates showed less interference with adjacent tissues, such as the masseter, when fixed to the mandible; and (4) mechanically, miniplates allow imposition of the masticatory loading to the bone flap rather than the plate, reducing the risk of bone resorption because of loss of functional occlusion. 40…”

Is Allergy to Titanium Bone Fixation Plates a Problem?

“…Titanium use in medicine is increasing; therefore, practitioners of different specialties encounter patients equipped with titanium implants in everyday practice [8,21,22]. Nowadays, open reduction and internal fixation (ORIF), with the aid of titanium hardware 1a,b, is the gold standard for maxillofacial fracture treatment [23][24][25]. The influence of titanium allergy on the bone fracture healing process and surgical treatment outcomes remains unclear [26].…”