Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.22
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2017, vol. 54, nr 3, July-September, p. 223–228

doi: 10.17219/dmp/75907

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Treatment of high fracture of the neck of the mandibular condylar process by rigid fixation performed by lag screws: Finite element analysis

Leczenie wysokiego złamania szyjki wyrostka kłykciowego żuchwy poprzez sztywne unieruchomienie śrubami – analiza z wykorzystaniem elementów skończonych

Marcin Kozakiewicz1,A,C,D,E,F, Jacek Świniarski2,A,B,C,E,F

1 Department of Maxillofacial Surgery, Medical University of Lodz, Łódź, Poland

2 Department of Strength of Materials and Structures, Technical University of Lodz, Łódź, Poland

Abstract

Background. From 1 to 4 fixing screws can be used clinically for rigid fixation of a mandibular condyle fracture, but contrarily, there is an opinion that insertion of even 3 screws in this region is technically impossible. On the other hand, the application of a single screw is the simplest technique. But if it is rigid?
Objectives. Evaluation of the rigidity of titanium lag screw fixation in a mandible high condyle neck fracture.
Material and Methods. A numerical analysis was performed using a model of a high condylar neck fracture. Fixation by 1, 2 or 3 lag screws were tested. The equivalent stress (S) distribution and displacement (D) of the fracture fragments were calculated.
Results. S = 464 MPa in 1-screw fixation and was spread widely in the condylar head (137 MPa) and downward in the distal mandibular fragment. In the 2-screw fixation, the anterior screw was more stressed (S = 319 MPa). Stress concentration in the condylar head was observed around the anterior screw (211 MPa) and spread toward the sigmoid notch in the distal bone fragment. The best biomechanical situation was in the 3-screw fixation (S = 222 MPa). The area of stress in the condylar head was limited and low (108 MPa), and the distribution of equivalent stress in the rest of the mandible was close to normal during mastication. Normal bone elasticity presented in the condyle neck was 9.6 ±3.7 μm during the occlusal load. In 1 screw D = 558 ±245 μm, for 2 screws D = 218 ±81 μm, and for the 3-screw fixation D = 217 ±144 μm. Two and 3 screw fixations were statistically better than the 1 screw rigid fixation (p < 0.001).
Conclusion. Open fixation by two 2.0 mm diameter lag screws is sufficiently rigid. The use of more screws seems to be unnecessary.

Key words

fracture, lag screw, mandibular condyle, rigid fixation

Słowa kluczowe

złamanie, śruba, wyrostek kłykciowy żuchwy, unieruchomienie sztywne

References (37)

  1. Puch A, Kurczyński M, Arkuszewski P, Bogusiak K. Overview of emergency department visits in Craniomaxillofacial and Oncological Clinic of Medical University in Lodz. Dent Med Probl. 2016;53:244–252.
  2. Bergh B, Blankestijn J, Ploeg T, Tuinzing DB, Forouzanfar T. Conservative treatment of a mandibular condyle fracture: Comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial. J Craniomaxillofac Surg. 2015;43:671–676.
  3. Loster JE, Wieczorek A, Ryniewicz WI. Condylar guidance angles obtained from panoramic radiographic images: An evaluation of their reproducibility. Dent Med Probl. 2017;54:35–40.
  4. Kolk A, Neff A. Long-term results of ORIF of condylar head fractures of the mandible: A prospective 5-year follow-up study of small-fragment positional-screw osteosynthesis (SFPSO). J Craniomaxillofac Surg. 2015;43:452–461.
  5. Li ZB. Condylar fractures, disc injury and development of temporomandibular joint ankylosis: discussion on the related problems. Zhonghua Kou Qiang Yi Xue Za Zhi. 2009;44:728–730.
  6. Zrounba H, Lutz JC, Zink S, Wilk A. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study. J Craniomaxillofac Surg. 2014;42:879–884.
  7. Krenkel C. Axial ‘anchor’ screw (lag screw with biconcave washer) or ‘slanted-screw’ plate for osteosynthesis of fractures of the mandibular condylar process. J Craniomaxillofac Surg. 1992;20:348–353.
  8. Neff A, Kolk A, Deppe H, Horch HH. Neue Aspekte zur Indikation der operativen Versorgung intraartikularer und hoher Kiefergelenkluxations frakturen. Mund Kiefer Gesichtschir. 1999;3:24–29 (in German).
  9. Rasse M. Neuere Entwicklungen der Therapie der Gelenkfortsatzbruche der Mandibula. Mund Kiefer Gesichtschir. 2000;4:69–87 [in German].
  10. Xu X, Ping YF, Yan JL. Application of lateral lag screw with sagittal condylar fracture and management of articular disk. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2008;37:519–523.
  11. Li Z, Li ZB. Reduction and screw fixation of condyle sagittal fracture. Zhonghua Kou Qiang Yi Xue Za Zhi. 2009;44:709–712.
  12. Neff A, Cornelius CP, Rasse M, Torre DD, Audigé L. The Comprehensive AOCMF Classification System: Condylar Process Fractures – Level 3 Tutorial. Craniomaxillofac Trauma Reconstr. 2014;7(Suppl 1): S044–S058.
  13. Bormann KH, Wild S, Gellrich NC, et al. Five-year retrospective study of mandibular fractures in Freiburg, Germany: incidence, etiology, treatment, and complications. J Oral Maxillofac Surg. 2009;67:1251–1255.
  14. Neff A, Mühlberger G, Karoglan M, et al. Stabilität der Osteosynthese bei Gelenkwalzenfrakturen in Klinik und biomechanischer Simulation. Mund Kiefer GesichtsChir. 2004;8:63–74 [in German].
  15. Schneider M, Eckelt U, Reitemeier B, et al. Stability of fixation of diacapitular fractures of the mandibular condylar process by ultrasound-aided resorbable pins (SonicWeld Rx(R) System) in pigs. Br J Oral Maxillofac Surg. 2011;49:297–301.
  16. Schneider M, Seinige C, Pilling E, et al. Ultrasound-aided resorbable osteosynthesis of fractures of the mandibular condylar base: an experimental study in sheep. Br J Oral Maxillofac Surg. 2012;50:528–532.
  17. Suzuki T, Kawamura H, Kasahara T, Nagasaka H. Resorbable poly‑L‑lactide plates and screws for the treatment of mandibular condylar process fractures: A clinical and radiologic follow-up study. J Oral Maxillofac Surg. 2004;62:919–924.
  18. Xin P, Jiang B, Dai J, et al. Finite element analysis of type B condylar head fractures and osteosynthesis using two positional screws. J Craniomaxillofac Surg. 2014;42:482–488.
  19. Mesnard M, Ramos A, Lokhov VA, Ballu A, Nyashin Yi, Simfies JA. Muscular and articular forces exerted on the mandible. ln: 1st International conference on biodental engineering. Porto, Portugal: CRC Press (Taylor 8 Francis), 2010;199–204.
  20. Iwasaki LR, Baird BW, McCaII Jr WD, Plickel JC. Muscle and temporomandibular joint forces associated with chin cup loading predicted by numerical modeling. Am J Orthod Dentofacial Orthop. 2003;124:530–540.
  21. Ramos A, Completo A, Relvas C, Mesnard M, Simoes JA. Straight semianatomic and anatomic TMJ implants: The influence of condylar geometry and bone fixation screws. J Cran Maxillofac Surg. 2011;39:343–350.
  22. Motoyoshi M, Ueno S, Okazaki K, Shimuzi N. Bone stress for a mini implant close to the roots of adjacent teeth – 3D finite element analysis. Int J Oral Maxillofacial Surg. 2009;38:363–368.
  23. Ichim I, Kieser JA, Swain MV. Functional significance of strain distribution in the human mandible under masticatory load: numerical predictions. Arch Oral Biol. 2007;52:465–473.
  24. Chossegros C, Cheynet F, Blanc JL, Bourezak Z. Short retromandibular approach of subcondylar fractures: clinical and radiologic long-term evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:248–252.
  25. Eulert S, et al. Study on treatment of condylar process fractures of the mandible. Ann Anat. 2007;189:377–383.
  26. Haug RH, Gilman P, Peterson GP, Goltz M. A biomechanical evaluation of mandibular condyle fracture plating techniques. J Oral Maxillofac Surg. 2002;60:73–80.
  27. Abdel-Galil K, Loukota R. Fractures of the mandibular condyle: evidence base and current concepts of management. Br J Oral Maxillofac Surg. 2010;48:520–526.
  28. Schneider M, et al. Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: A randomized, prospective, multicenter study with special evaluation of fracture level. J Oral Maxillofac Surg. 2008;66:2537–2544.
  29. Aquilina P, Chamoli U, Parr WCH, Clausen PD, Wroe S. Finite element analysis of three patterns of internal fixation of fractures of the mandibular condyle. Br J Oral Maxillofac Surg. 2013;51:326–331.
  30. Wagner A, Krach W, Schicho K, Undt G, Ploder O, Ewers R. A 3-dimensional finite-element analysis investigating the biomechanical behaviour of the mandible and plate osteosynthesis in cases of fractures of the condylar process. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:678–686.
  31. Eckelt U, Hlawitschka M. Clinical and radiological evaluation following surgical treatment of condylar neck fractures with lag screws. J Craniomaxillofac Surg. 1999;27:235–242.
  32. Pilling E, Schneider M, Mai R, Loukota RA, Eckelt U. Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle. J Oral Maxillofac Surg. 2006;64:868–872.
  33. Kozakiewicz M, Swiniarski J. “A” shape plate for open rigid internal fixation of mandible condyle neck fracture. J Craniomaxillofac Surg. 2014;42:730–737.
  34. Aquilina P, Parr WCH, Chamoli U, Wroe S. Finite element analysis of patient-specific condole fracture plate: A preliminary study. Craniomaxillofac Trauma Reconstr. 2015;8:111–116.
  35. Boffano P, Benech R, Gallesio C, Arcuri F, Benech A. Current opinions on surgical treatment of fractures of the condylar head. Craniomaxillofac Trauma Reconstr. 2014;7:92–100.
  36. Karoglan M, Schutz K, Schieferstein H, Horch HH, Neff A. Development of a static and dynamic simulator for osteosyntheses of the mandible. Technol Health Care. 2006;14:449–455.
  37. Neff A, Kolk A, Neff F, Horch HH. Surgical vs. conservative therapy of diacapitular and high condylar fractures with dislocation. A comparison between MRI and axiography. Mund Kiefer Gesichtschir. 2002;6:66–73.