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Comparison of two L shaped Plate on Plate Versus Single Conventional L Miniplate in Fixation of Subcondylar Mandibular Fractures.

ABSTRACT: Aim:To compare and evaluate treatment outcome and postoperative complications in subcondylar fractures of mandible-single L shape plate versus two L shape plate-using plate on plate technique. Materials and Methods:The clinical trial had a total of ten patients (ten unilateral subcondylar fracture sites), which were divided randomly into two groups of five each. Group I patients underwent open reduction and internal fixation with single L shaped miniplate and Group II ORIF was done with two L shaped miniplates by plate on plate technique. Results:Both the groups showed comparable results in terms of postoperative complications. Few cases in Group I presented with minor occlusal discrepancy which was easily corrected with transitional inter-maxillary fixation(IMF) for 1 week, and none of the Group II cases required postoperative IMF, but stability in Group II was better than Group I. Conclusion:The results of this trial suggested that the treatment of mandibular condylar fractures with 2 (2-D) plates placed one over the other is better suited than conventionally practiced single-plate fixation. Increased 3-dimensional stability, low morbidity and infection rates are the advantages offered by 2-plate technique of ours.

SUBMITTER: Pappachan B

PROVIDER: S-EPMC6639440 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Comparison of two L shaped Plate on Plate Versus Single Conventional L Miniplate in Fixation of Subcondylar Mandibular Fractures.

Pappachan Biju B Agrawal Raghav R

Journal of maxillofacial and oral surgery 20181015 3

<h4>Aim</h4>To compare and evaluate treatment outcome and postoperative complications in subcondylar fractures of mandible-single L shape plate versus two L shape plate-using plate on plate technique.<h4>Materials and methods</h4>The clinical trial had a total of ten patients (ten unilateral subcondylar fracture sites), which were divided randomly into two groups of five each. Group I patients underwent open reduction and internal fixation with single L shaped miniplate and Group II ORIF was don ...[more]

PMID: 31371888

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Project description:BackgroundMandibular fractures constitute about 80.79% of maxillofacial injuries in Alexandria University, either as isolated mandibular fractures or as a part of panfacial fractures. The combination of symphyseal and parasymphyseal fractures represent 47.09% of the total mandibular fractures.AimTo compare the effectiveness of lag screws vs double Y-shaped miniplates in the fixation of anterior mandibular fractures.MethodsThis study is a prospective randomized controlled clinical trial, performed on sixteen patients with anterior mandibular fractures. Patients were divided equally into two groups, each consisting of eight patients. Group 1: Underwent open reduction and internal fixation using two lag screws. Group 2: Underwent open reduction and internal fixation using double Y-shaped plates. The following parameters were assessed: operating time in minutes, pain using a visual analog scale, edema, surgical wound healing for signs and symptoms of infection, occlusion status and stability, maximal mouth opening, and sensory nerve function. Cone beam computed tomography was performed at 3 and 6 mo to measure bone density and assess the progression of fracture healing.ResultsThe study included 13 males (81.3%) and 3 females (18.8%) aged 26 to 45 years (mean age was 35.69 ± 6.01 years). The cause of trauma was road traffic accidents in 10 patients (62.5%), interpersonal violence in 3 patients (18.8%) and other causes in 3 patients (18.8%). The fractures comprised 10 parasymphyseal fractures (62.5%) and 6 symphyseal fractures (37.5%). The values of all parameters were comparable in both groups with no statistically significant difference except for the mean bone density at 3 mo postoperatively which was 946.38 ± 66.29 in group 1 and 830.36 ± 95.53 in group 2 (P = 0.015).ConclusionBoth lag screws and double Y-shaped miniplates provide favorable means of fixation for mandibular fractures in the anterior region. Fractures fixed with lag screws show greater mean bone density at 3 mo post-operation, indicative of higher primary stability and faster early bone healing. Further studies with larger sample sizes are required to verify these conclusions.

Project description:PurposeThe treatment of distal femur fractures with extensive metaphyseal comminution is frequently complicated by high rates of nonunion and varus collapse. Dual plating with lateral and medial locking plates for these types of fractures has shown promising results in the recent literature. We hypothesize that dual plating of comminuted distal femur fractures leads to higher union rates and lower revision rates compared to an isolated lateral locking plate.MethodsA retrospective medical chart review between January 2015 and December 2017 was conducted. Inclusion criteria included patients 18 years of age and older who sustained a complex distal femur fracture (AO/OTA 33-C2/33-C3 or periprosthetic fracture with significant metaphyseal comminution) and at least 6 months of follow up. Patients with simple fracture patterns, alternative fixation methods, and inadequate follow up were excluded. All patients in the single plating group were treated with a lateral distal femoral locking plate using a lateral approach. In the patients treated with dual plating, an extensile parapatellar approach was utilized for fracture reduction and placement of an adjunctive medial plate. Demographic information, fracture types, injury severity score (ISS), medical comorbidities, type of surgical fixation, union rates, complications, knee range of motion, time to follow up, and need for revision surgery were extrapolated from the medical charts for analysis.ResultsTwenty-one patients were included in the study. Thirteen patients underwent single plate fixation and 8 underwent dual plate fixation. There were no significant differences in demographics, number of co-morbidities, fracture classification, or ISS between single and dual plate groups (p > 0.05 for all). There was a statistically significant difference in union rates between the single plate group (6 nonunions, 4 unions, and 3 delayed unions) and the dual plate group, with no nonunions or delayed unions (p = 0.0049). Although not statistically significant, 4 patients treated with single plating underwent revision ORIF, compared to none in the dual plating group (p = 0.13). There were no significant differences in time to follow up, time to full weight bearing, or infection rates (p > 0.1 for all).ConclusionBased on these results, the medial and lateral locked plating technique demonstrates a higher union rate, with possible lower rates of revision surgery, compared to a single lateral plate in highly comminuted distal femur fractures.Level of evidenceLevel 3. Retrospective Cohort Study.

Project description:BACKGROUND:It is still unknown whether bioabsorbable magnesium (Mg) screws provide an advantage over titanium screws in the treatment of medial malleolar (MM) fractures. The purpose of this retrospective study is to compare the clinical and radiological outcomes of MM fractures fixed with either bioabsorbable Mg screws or conventional titanium screws. MATERIALS AND METHODS:A cohort of 48 patients with MM fractures who underwent compression screw fixation was retrospectively reviewed. Twenty-three patients (16 male, 7 female; mean age: 37.9?±?17.7 years) were treated with bioabsorbable Mg screws, and 25 patients (14 male, 11 female; mean age: 45.0?±?15.7 years) were treated with conventional titanium screw fixation. All patients were followed up for at least 1 year, with a mean time of 24.6?±?10.5 months (12-53 months). The American Orthopedic Foot and Ankle Society (AOFAS) scale was used to evaluate the clinical results. The Kellgren-Lawrence (KL) osteoarthritis grading was used to evaluate posttraumatic osteoarthritis on final ankle radiographs. Fracture union, rate of implant removal, and complications were recorded. Comparative analysis of two independent groups was performed using the chi-squared test and the Mann-Whitney U-test. RESULTS:The two groups were comparable concerning demographic and clinical characteristics. Age (p?=?0.146), sex (p?=?0.252), side (p?=?0.190), MM fracture type (p?=?0.500), associated fractures (p?=?0.470), and follow-up period (p?=?0.903) were similar between the groups. At final follow-up examination, AOFAS score (p?=?0.191) was similar between groups. Fracture union was achieved in all cases. Grade of posttraumatic osteoarthritis, according to KL, was equally distributed in both groups (p?=?0.074). No deep infection or osteomyelitis was seen. Five patients in the titanium screw group underwent implant removal, due to pain in three of them and difficulty in wearing shoes in the other two (p?=?0.031). Implant removal was performed after a mean of 14.2?±?3.1 months (12-19 months). CONCLUSIONS:Bioabsorbable Mg and titanium screws had similar therapeutic efficacy in MM fracture fixation regarding functional and radiological outcomes. However, the rate of implant removal was higher with titanium screws. Bioabsorbable Mg screws may be a favorable fixation option since secondary implant removal procedures can be prevented. LEVEL OF EVIDENCE:Level IV, Retrospective case series.

Project description:Of all distal radius fractures, 25 % are complete articular fractures (AO/OTA type C fractures). Two thirds of those fractures are displaced and require reduction. According to several International Guidelines, adequately reduced intra-articular distal radius fractures are best treated non-operatively with plaster immobilisation, while surgical fixation is suggested only when the articular step exceeds 2 mm after reduction. However, these recommendations are based on studies that did not differentiate between intra- and extra-articular distal radius fractures. Thus, no clear consensus about the best treatment for patients with displaced intra-articular distal radius fractures can be reached. Despite the lack of evidence, an increase in internal fixation of intra-articular distal radius fractures has been observed over the last decade. The aim of this study is to determine the difference in functional outcome following open reduction and plate fixation compared with non-operative treatment with closed reduction and plaster immobilisation in patients with a displaced intra articular distal radius fracture.This multicentre randomised controlled trial will randomise between open reduction and internal plate fixation (intervention group) and closed reduction and plaster immobilisation (control group). All consecutive adult patients from 18 to 65 years with a displaced intra-articular distal radius fracture (AO/OTA type C), which has been adequately reduced at the Emergency Department according to the Dutch National Guidelines, are eligible for inclusion in this study. The primary outcome is function and pain of the wrist assessed with the Patient-Rated Wrist Evaluation score (PRWE). Secondary outcomes are the Disability of the Arm, Shoulder and Hand score (DASH), pain, quality of life (SF-36), range of motion, grip strength, radiological parameters, complications, crossovers and cost-effectiveness of both treatments. A total of 90 patients will be included in this study.Although displaced intra-articular distal radius fractures are common, there is still no evidence on the optimal treatment for these fractures in patients aged 18 to 65 years. Therefore we aim to determine the difference in functional outcome between open reduction and plate fixation and closed reduction and plaster immobilisation.This study is registered at ClinicalTrials.gov ( NCT02651779 ) on January 4(th) 2016.

Dataset Information

Comparison of two L shaped Plate on Plate Versus Single Conventional L Miniplate in Fixation of Subcondylar Mandibular Fractures.

Publications

Comparison of two L shaped Plate on Plate Versus Single Conventional L Miniplate in Fixation of Subcondylar Mandibular Fractures.

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