This document discusses different plating systems used in maxillofacial trauma. It describes the goals of fracture fixation as reduction of bone fragments, stable fixation, preservation of blood supply, and early functional mobilization. It then explains several plating systems in detail, including miniplate fixation, microplate fixation, compression plates, locking plates, reconstruction plates, and bioresorbable plates. Each system is outlined in terms of its advantages and disadvantages for fracture management.
6. Load bearing system
plate bears the functional
load at the fracture site
accomplished with a locking
reconstruction plate.
Clinical uses are the
management of atrophic
edentulous fractures,
comminuted fractures and
complex mandibular
fractures.
8. RIGID and SEMIRIGID FIXATION
Does not allow micromotion of fracture segments during
functional movements
Absolute rigid fixation not necessary for successful healing
(Selection of Internal Fixation Devices for Mandibular Fractures: How Much Fixation
Is Enough? Edward Ellis Seminars in Plastic Surgery 2002; 16(3): 229-240
DOI: 10.1055/s-2002-34430)
Additional plates required to establish absolute rigidity-
increases complication rate
(Ellis, Edward, and Lee R. Walker. "Treatment of mandibular angle fractures using
one noncompression miniplate." Journal of oral and maxillofacial surgery 54.7
(1996): 864-871.)
9. GOALS OF FIXATION
REDUCTION OF BONE FRAGMENTS
STABLE FIXATION
PRESERVATION OF BLOOD SUPPLY
EARLY FUNCTIONAL MOBILISATION
11. MINIPLATE FIXATION SYSTEM
MITCHEL et al 1960s, CHAMPY et
al 1976
Goal-to provide stable fracture
reduction without interfragmentary
compression or MMF
Advantages-reduced size, smaller
incisions and less tissue
dissection,less paplpable, reduced
necessity of removal
screws are monocortical – can be
placed in areas adjascent to tooth
roots with minimal risk of injury
12. Disadvantages
Decreased rigidity- torsional movements under
functional loading
Cannot be used in comminuted fractues
Functional restriction recommended
13.
14. MICROPLATE FIXATION SYSTEM
Muscular forces on midface skeleton are much less
Thinner and malleable microplates used
Low profile- advantageous in areas of minimum
overlying soft tissue
Application through smaller incisions in aesthetically
sensitive areas
15. Can be used for fixation of bones in
Cranium , orbital rim, zygomatic process, anterior
maxilla and NOE complex
16. Compression plating system
load-sharing osteosynthesis –dynamic,eccentric dynamic
EDCP- used when tension band not possible-edentulous,
impacted third molar,avulsion of bone from fracture
ensures good interfragmentary compression and thus
good bony buttressing
17.
18. As the eccentrically placed compression screws are
tightened, the head moves down the ramp and the bone
is compressed together
19. Plate must be slightly overbent
To close lingual gap(1-2mm)
20. Indicated in nonoblique fractures with good bony
apposition after reduction
Disadvantages- technique sensitive,plate should be
precisely adapted to bone
Use in oblique fractures- can lead to overriding
segments
22. Screw locks to plate independent of bone-fracture stability
without direct bone contact
Thus precise plate adaptation not manadatory
More viable periosteum as plate does not compress bone
Minimises complications with loose screws
Can be used in severe oblique fractures, comminuted
fractures and fractures with bone loss
23. Reconstruction plates
Load bearing
In cases of bone loss, gross instability or severe
comminuted fractures, edentulous atrophic mandibles
The plate must be long enough so that there can be a
minimum of three or preferably four screws on each side
of the fracture.
The screws adjacent to the fracture should be at least 7
mm away from the fracture line.
24. Bioresorbable plating system
Metallic plates- growth restriction and plate translocation
Bioresorbable plates- SR-PLA, SR PGA
Advantage-iitial rigid fixation.as bone heals-plate
resorbs, reduces stress shielding effect
Disadvantages-long resorption time, sterile fluid
accumulations have been reported, less stable than
conventional systems