Short communicationFixation of comminuted diacapitular fractures of the mandibular condyle with ultrasound-activated resorbable pins
Introduction
The fixation of fractures of the mandibular condylar head, neck, and base has long been debated by maxillofacial surgeons, and the fixation of diacapitular fractures1 or high fractures of the condylar neck has been resisted because of the technical difficulty involved. However, a recent prospective randomised multicentre trial indicated that fixation of these fractures is beneficial to the patient.2
Comminuted fractures are difficult to treat, particularly with metallic screws as the screw tends to cause the condylar head to fragment further. The mechanics of fixation with lag screws within the condylar region have been illustrated both clinically and biomechanically,3 and the biomechanical stability and resorption of resorbable pins have also been studied.4, 5
We describe the fixation of bilateral diacapitular fractures of the condylar head with ultrasound-activated resorbable pins (KLS Martin SonicWeld Rx®).
Section snippets
Case study
A dentate woman with bilateral dislocated and comminuted diacapitular condylar fractures presented with pain, altered occlusion, and limited mouth opening.
She was assessed clinically and radiographically (Fig. 1). Computed tomography (Fig. 2) showed that the proximal fragments of the condylar head were displaced anteromedially bilaterally.
We took her symptoms and the presence of comminution at the fracture sites as contraindications for the usual operation (fixation with lag screws or headless
Results
Postoperative radiographs showed the repositioning of the proximal fragments (Fig. 3). The patient reported improvement of her occlusion and a reduction in pain. Six weeks postoperatively she had normal mandibular movements (mouth opening of more than 40 mm, and lateral excursions of more than 7 mm bilaterally).
Discussion
Osteosynthesis of fractures of the condylar head is technically difficult; the use of miniplates requires extended exposure and increases the risk of scar-induced limitation of postoperative translation in the joint up to 30%. The need to minimise reflection of periosteum has been emphasised by Rasse.7
Osteosynthesis using lag screws is functionally stable; it provides moderate pressure on the bony ends at the fracture gap while reducing the formation of connective tissue and callus. It also
Acknowledgement
We thank KLS Martin for provision of the custom-made SonicWeld® pins.
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An experimental in vivo analysis of the resorption to ultrasound activated pins (Sonic weld®) and standard biodegradable screws (ResorbX®) in sheep
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Plating Options for Fixation of Condylar Neck and Base Fractures
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