The Stability Evaluation of Two Internal Fixation Patterns of Extracapsular Condylar Fracture Based on One Novel Measuring Method

Abstract

Purpose: The most stable internal fixation pattern for extracapsular condylar fracture (ECF) has been controversial. In this study we aimed to evaluate the stability of 2 common internal fixation patterns using 1 or 2 miniplates separately. One novel measuring method based on the angle of miniplates’ localization was introduced. Materials and Methods: Twenty-seven patients with 30 sides of extracapsular condylar fracture were enrolled in this retrospective study. All cases were performed open reduction and internal fixation using 1 or 2 titanium plates with both the postoperative immediate CT (T1) and the over 6 months’ follow-up CT (T2). Mandibles and implants were segmented and reconstructed respectively using SIMPANT 14.04 software. For 1 miniplate group, the sagittal crossing angle (<1) between miniplate (P1) and posterior border of ipsilateral ramus was measured. For 2 miniplates group, the sagittal crossing angle (<2) between 2 miniplates (P2a, P2b) was measured. Both anteroposterior (∠AP) and mediolateral angle change (∠ML) of each miniplate between T1 and T2 was measured. The stability of 2 internal fixation patterns was measured and evaluated based on the angle change of miniplates. And also the stability of each internal fixation pattern could be investigated based on the relationship between the placement patterns of miniplates and the angle change. Results: Fifty-two miniplates were finally segmented and reconstructed successfully, including 8 of 1 miniplate group and 44 of 2 miniplate group. For 1 miniplate group, the average ∠AP and ∠ML were 6.10° and 8.54°, respectively. For 2 miniplate group, the average ∠AP and ∠ML of P2a were 3.02° and 2.56°, respectively, as well as 3.12° and 3.07° of P2b. Conclusions: The novel measuring method based on the angle of miniplates’ localization showed potential for the stability evaluation of internal fixation of condylar fracture. In summary, the internal fixation patterns using 2 miniplates shows better stability than that of 1 miniplate.

Evaluation of the Efficacy of Three Times Titanium Plate Gradual Fixation Method in the Treatment of Extracapsular Condylar Fractures

“…1A). With the help of the anesthesiologist using muscle relaxant to relax the muscles, and with the assistance of the assistant using a wire ring to pull down the mandibular branch to pull out the broken end of the bone externally after pulling down the jaw branch 3 (Fig. 1B), and then through the following steps to complete repositioning and fixation: first, the first continuous 4-hole titanium plate was fixed to the proximal fracture segment of the condyle with one screw, and the titanium plate was temporarily fixed to the lateral aspect of the ascending mandibular branch with one screw (Fig.…”

“…C ondylar fractures account for 25% to 35% of mandibular fractures, 1 and often cause occlusal and mandibular dyskinesia when displacement and dislocation occur. Condylar fractures are usually classified as intracapsular condylar neck fractures and subcondylar neck fractures according to the height of the fracture line, 2 and in the case of neck fracture and subcondylar neck fracture, surgical incision and internal fixation are necessary to restore occlusal function and facial symmetry, 3 and the surgical difficulty of the operation is, firstly, due to the edema of the extensor pterygoideus muscle, the atrophy and even the fibrosis due to the change of time, which makes the broken. The difficulty is due to edema, atrophy, and even fibrosis due to time changes, which makes it more difficult to bring the segment back to the condylar process of anterior internal dislocation into the articular recess, and because of the low to moderate fracture position, which can be held to a small extent.…”

A Novel Technique for Reduction and Fixation of Severe Extracapsular Condylar Fracture

“…So severe extracapsular condylar fracture presents an occlusal disorder, limited mouth opening, and clinical facial asymmetry. To rehabilitate the occlusal function and restore facial symmetry, open reduction and internal fixation of the severe extracapsular condylar are recommended 4. However, the presence of a nearby facial nerve limits the exposure of the extracapsular condylar fracture, making it difficult to access the condylar head and fix the fracture segment, especially in the case of condylar segment dislocation.…”