Fixation of intracapsular fractures of the condylar head with bioabsorbable screws
Department of Plastic and Reconstructive Surgery, Aizu Central Hospital, Fukushima, Japan.Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery (Impact Factor: 0.94). 02/2006; 40(4):244-8. DOI: 10.1080/02844310510042358
A newly-developed fixation technique using bioabsorbable screws gave satisfactory results in fractures of the condylar head. The fracture lines ran obliquely (craniolateral to mediocaudal) on three-dimensional computed tomography. Two bioabsorbable screws were positioned vertically to the fracture lines. This technique is useful despite limited access to the condyle.
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ABSTRACT: Although a tibial inlay technique for posterior cruciate ligament reconstruction is advantageous, metallic screw fixation of the bone block is required. This may pose problems for future surgery (eg, osteotomies, total knee replacement). There is no significant difference in the biomechanical integrity of bone block fixation using stainless steel versus bioabsorbable screw fixation of the tibial inlay graft in posterior cruciate ligament reconstruction. Controlled laboratory study. Fourteen human cadaveric knees were randomized to receive either stainless steel or bioabsorbable screw fixation of a bone-patellar tendon-bone graft. Cyclic tensile testing of each construct was performed, followed by a load-to-failure test. Digital video digitization was used to optically determine tendon graft deformation. Cyclic creep deformation showed no significant difference between the 2 groups (P = .8). The failure load (stainless steel, 461 +/- 231 N; bioabsorbable, 638 +/- 492 N; P = .7) and linear stiffness (stainless steel, 116 +/- 22 N/mm, bioabsorbable, 106 +/- 44 N/mm; P = .6) also showed no significant difference between the 2 groups. Optically measured graft deformation was not significant for distal (P = .7) and midsubstance (P = .8) regions, while proximal deformation was significantly higher for bioabsorbable fixation (P = .02). All samples failed at the tibial insertion site with the tibial bone block fracturing at the screws. Bioabsorbable screw fixation using a tibial inlay technique does not compromise the strength and stiffness characteristics afforded by metallic fixation. From a biomechanical perspective, bioabsorbable screws are a viable alternative to metal in the context of tibial inlay reconstruction. Use of bioabsorbable fixation can potentially eliminate future hardware problems after posterior cruciate ligament reconstruction using a tibial inlay technique.The American Journal of Sports Medicine 02/2009; 37(4):748-53. DOI:10.1177/0363546508328106 · 4.36 Impact Factor
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ABSTRACT: The purpose of the study was to review the literature regarding the evolution of current thoughts on management of diacapitular fractures (DFs) of the mandibular condyle. An electronic search in PubMed was undertaken in March 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies reporting clinical series of DFs, including both animal and human studies, without date or language restrictions. The search strategy initially yielded 108 references. Twenty-eight studies were identified without repetition within the selection criteria. Additional hand-searching of the reference lists of selected studies yielded three additional papers. The current indications for open reduction and internal fixation (ORIF) of DFs described in the literature are: (a) fractures affecting the lateral condyle with reduction of mandibular height; (b) fractures in which the proximal fragment dislocates laterally out of the glenoid fossa, which cannot be reduced by closed or open treatment of another part of the mandibular fracture. The indications for conservative treatment are: (a) fractures that do not shorten the condylar height (a fracture with displacement of the medial parts of the condyle); (b) undisplaced fractures; (c) comminution of the condylar head, when the bony fragments are too small for stable fixation; and (d) fractures in children. As the temporomandibular joint disk plays an important role as a barrier preventing ankylosis, it is important to reposition the disk (if displaced/dislocated) during the surgical treatment of DFs. The lateral pterygoid muscle should never be stripped from the medially displaced fragment because its desinsertion disrupts circulation to the medial bony fragment, and also because this muscle helps to restore the muscle function after surgery. ORIF of selected DFs improves prognosis by anatomical bone and soft tissue recovery when combined with physical therapy. If conducted properly, surgical treatment of DFs is a safe and predictable procedure and yields good results.Oral and Maxillofacial Surgery 07/2012; 16(3):257-65. DOI:10.1007/s10006-012-0337-6
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ABSTRACT: The aim of this study was to explore the cause of type B condylar head fracture after parasymphyseal impact, and evaluate the biomechanics of osteosynthesis using two positional screws for the repair of this type of fractures. A finite element model of the mandible was created, and a parasymphyseal impact was simulated using Mimics 10.01 and Abaqus 6.10 software. The type B condylar head fracture was simulated in the right condyle using a mimics simulation cut with polyplane module according to the analyzed results together with clinical experience, and the left condyle was used as a control. Two positional screws were used for rigid internal fixation of the fracture. von Mises stress distributions in the condyles and screws were analyzed. The von Mises stress generated in parasymphyseal trauma simulation showed a significant concentration in the sagittal direction of the condyle. In two-positional-screw osteosynthesis of the condylar head fractures, stress concentration appeared within the screws in the gap area between the two fractured segments and the area around the screw head. A small amount of stress was distributed in the screw holes and on the posterior surfaces of both segments. The von Mises stress was negligible in the fractured sagittal surfaces. It is reasonable to attribute the cause of type B condylar head fracture to the anatomical features of the condyle. The biomechanics of two-positional-screw osteosynthesis revealed that the stress can transmit through the screws to the medial fragments, and the stresses on both sagittal fractured surfaces are minimal.Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 07/2013; 42(5). DOI:10.1016/j.jcms.2013.06.006 · 2.93 Impact Factor
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