Short communication
Fixation of comminuted diacapitular fractures of the mandibular condyle with ultrasound-activated resorbable pins

https://doi.org/10.1016/j.bjoms.2007.11.025Get rights and content

Abstract

We describe the fixation of bilateral comminuted diacapitular fractures of the mandibular condyle with ultrasound activated resorbable pins (KLS Martin SonicWeld Rx®) by an open approach with primary fixation of the fractures using the resorbable osteosynthesis 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.

Cited by (32)

  • Prognostic factors for long-term results after condylar head fractures: A comparative study of non-surgical treatment versus open reduction and osteosynthesis

    2020, Journal of Cranio-Maxillofacial Surgery
    Citation Excerpt :

    Rasse (2000) was the first to describe the technique of ORIF of CHFs with resorbable pins. Since then, additional surgical approaches and fixation techniques have been published (Neff et al., 2005; Kolk and Neff, 2015; Neff, 2019; Pilling et al., 2006; McLeod and Saeed, 2016; Abdel-Galil and Loukota, 2008). Advances in surgical techniques and tools have made ORIF less invasive and have decreased the occurrence of complications.

  • Trauma to the Pediatric Temporomandibular Joint

    2018, Oral and Maxillofacial Surgery Clinics of North America
    Citation Excerpt :

    This approach, however, provides limited access and requires specialized instruments and operator experience to achieve success. Fixation options typically include a triangular configuration of 2 4-hole plates (Fig. 6), 1 4-hole plate, lag screws, Kirschner wire, cannulated lag screw,89,90 resorbable poly-D/L-lactide 3-D mesh prebend on a 3-D anatomic model,91 and ultrasound-activated resorbable pin (Fig. 7).92,93 Fracture of the temporal bone with condylar intrusion into the middle cranial fossa has also been reported in 67 cases thus far (Fig. 8).75,76,94,95

  • Plating Options for Fixation of Condylar Neck and Base Fractures

    2017, Atlas of the Oral and Maxillofacial Surgery Clinics of North America
View all citing articles on Scopus
View full text