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This requires solid bony fragment on each side of # to bear some of the loads Examples of load-sharing fixation device- miniplate, lag screw and compression plates 4/21/2013 FAMUREWA & OLADEJO 31Compression vs Non compression plates Bone plates are either compression or non compression plates Compression is obtained by tightening screws down a ramped hole design. The compression holes are drilled eccentrically to allow for compression.Typically, the holes on either side of the fractures are designated for compression screw placement.
3D plates and plates with angles are frequently utilised Other plates in mandibular modules may be used 4/21/2013 FAMUREWA & OLADEJO 66RECONSTRUCTION Plates may be used to retain bone graft or flap Recon plates which may be locking or non locking are used Locking plates are preferred They require at least 3 screws on either side for adequate stability. Invited review: small versus large plate fixation of mandibular fractures.
Condylar pieces are available for replacement 4/21/2013 FAMUREWA & OLADEJO 67Local Experience??? J Craniomaxillofac Trauma 1999;5(3):33-9; discussion 40.
4/21/2013 FAMUREWA & OLADEJO 33Compression vs Non compression plates Compression plates offer rigid fixation.
Has higher risk if not performed perfectly Makes use of bicortical screws Not commonly in use Demerits- bulky, not malleable, gap in lingual plate if overbent 4/21/2013 FAMUREWA & OLADEJO 35Locking vs non locking plates Conventional plates are non locking(to the screws).
4/21/2013 FAMUREWA & OLADEJO 3INDICATIONS Trauma- facial bone fracture Orthognathic surgery Reconstruction of craniofacial deformities Reconstruction of bony defects 2 ͦ to ablative tumour surgery.
Augmentation of atrophic mandible in the elderly Iatrogenic -2 ͦ to anterior/lateral mandibulotomy 4/21/2013 FAMUREWA & OLADEJO 4HISTORY Hippocrates(460-375 BC) - use of gold wires, linen thread & strips of leather for treating mandibular fractures.
There is formation of periosteal callus- to “immobilize” the segment Bone healing proceed from haematoma collection to differentiation of fibrous tissue to osseous tissue 4/21/2013 FAMUREWA & OLADEJO 27Load-bearing vs load-sharing fixation Load-bearing fixation is a device that is of a sufficient strength & rigidity that it can bear the entire load applied to the mandible during function.
Indications for load-bearing fixation: Comminuted mandibular # Continuity defect of the mandible # of the atrophic edentulous mandible Reconstruction plate –example of device 4/21/2013 FAMUREWA & OLADEJO 29Load-sharing fixation Load-sharing fixation is any fixation that is of insufficient stability to bear all of the functional loads applied across the # by the masticatory system.
edentulous jaws) Plates not as thick as 3mm are not recommended for defect bridging May use 2.4, 2.7 or 3.0mm screws depending on system. Several advances have been made in implant science and instrumentation.
UFP (Universal Fracture Plate) 2.4mm Thorp system: hollow screws Lag Screws 4/21/2013 FAMUREWA & OLADEJO 49Resorbable Fixation System Not really intended for use in the mandible Not for load bearing Use of the Resorbable Fixation system is contraindicated in the presence of: Active or Latent infections. However, cost still remains a serious challenge Incorrectly applied implants can also cause more harm than good.