Open Rigid Internal Fixation of Low-Neck Condylar Fractures of the Mandible: Mechanical Comparison of 16 Plate Designs

Abstract

Background: In the literature, no information on plates for low-neck mandibular condylar osteosynthesis can be found, despite the fact that 30 plate designs have already been published. The aim of this study was to compare any dedicated plates for possible use in low-neck condylar fracture osteosynthesis. Methods: The force required for 1-mm displacement of the fixed fracture fragments and incidents of screw loosening were recorded on polyurethane mandibles among 16 designs of titanium plates fixed by 6-mm screws in a 2.0 system. Results: Double-straight plate fixation was the mechanical gold standard (15.2 ± 3.5 N), followed by A-shape Condylar Plates (14.9 ± 2.1 N), X-shape Condylar Plates (14.2 ± 1.3 N) and Auto Repositioning Plates (11.8 ± 2.4 N). Screw loosening was uncommon, as a minimum of three screws were placed into the condylar part. Fewer screws were lost from the ramus part of the fixation if the plate was attached to the condylar part by three screws. Often, the stability of the ramus screws was lost when there were only two fixing screws in the condyle (p < 0.001). Conclusions: It is advisable to consider the mechanical advantages as one decides which plate to choose for open rigid internal fixation in low-neck condylar fractures, or to only be aware of the significant differences in mobility within the fracture line after fixation with different dedicated plates.

Choice of Screws for Fixation of Mandibular Condyle Fractures Guided by Anthropometric Data

“…Rigid fixation is considered the treatment of choice by many authors in fractures of the condylar process [18] and the mandibular head [2], ensuring the anatomical stability of the osteosynthesis [19], which is necessary to obtain the correct occlusion after the procedure [20], in addition to recovery and efficient mastication. Complications associated with abnormal union formation after fracture fixation are associated with infection, an atrophic mandible, inappropriate reduction, multiple fractures, repeated trauma, patient compliance, and, in particular, poor stability [21].…”

“…Small plates do not perform well mechanically [26]. However, among the many plate shapes available, it is possible to choose the most durable plate as a base for the condyle fracture [27] (which is a relatively easy fracture to treat) and for ORIF of the condylar neck [20,28]. Due to limited space, ensuring proper fixation stability is a challenge, especially in the condylar neck top region [28].…”

Assessment of Differences in the Dimensions of Mandible Condyle Models in Fan- versus Cone-Beam Computer Tomography Acquisition

“…Following the image of the cone-beam tomography in the area of the thin bone, the surgeon may decide to use shorter screws for fracture osteosynthesis to avoid through and through osteosynthesis. The use of a shorter screw adversely affects the pull-out force of the miniplate [ 35 , 36 ] and the screws [ 34 , 37 , 38 ].…”

The Use of Titanium 3D Mini-Plates in the Surgical Treatment of Fractures of the Mandibular Condyle: A Systematic Review and Meta-Analysis of Clinical Trials

“…Despite the ongoing evaluation of operational techniques, no consensus has been reached on the type and shape of the fixation material [6,8,9]. There are known ways to fix condyles with screws, but mini-plates dominate around the base and the lower part of the neck [6][7][8]10]. While classic techniques assume the use of straight mini-plates, used for fixation of other craniofacial bones, recent years have confirmed the popularity of 3D mini-plates with dedicated shapes [6][7][8].…”