Wire Osteosynthesis in the Treatment of Mandible Fractures in Low Resource Settings: A Force Study.

IF 0.8 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Craniomaxillofacial Trauma & Reconstruction Pub Date : 2024-03-01 Epub Date: 2022-12-20 DOI:10.1177/19433875221143605
Shekhar K Gadkaree, Adeeb Derakhshan, Victor Nyabenda, Isaie Ncogoza, Gratien Tuyishimire, David A Shaye
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Abstract

Study design: Cadaveric investigation.

Objective: Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF.

Methods: Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site.

Results: For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-of-eight wiring, and plating respectively (P < .001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (P < .001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (P = .002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (P = .29).

Conclusions: Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures.

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钢丝骨合成术在资源匮乏地区下颌骨骨折治疗中的应用:力量研究。
研究设计尸体调查:在中低收入国家,由于资源有限,使用钢板和螺钉进行刚性内固定(RIF)往往不可行。通常使用骨间布线来实现半刚性固定,但缺乏生物力学力数据。在此,我们旨在定量比较骨间接线和 RIF:方法:尸体下颌骨骨骺旁和骨骺角骨折。采用单线环形和八字形骨间布线固定,以及钢板和螺钉固定(每个骨折部位每种固定方式的人数均为 5 人)。使用测力计测量固定部位达到舒张和完全破坏所需的牛顿(N)数:对于角状骨折,单线、八字形接线和钢板固定的初始舒张力平均值分别为 4.1、5.9 和 10.9 牛顿(P < .001)。三种方法的完全失败力分别为 152.9、168.9 和 237.6 牛顿(P < .001)。对于骺旁骨折,单线、八字形布线和钢板接合的完全失败力分别为 197.7、263.0 和 262.8 牛顿(P = .002)。三种固定方法在实现骺旁骨折初始舒张力方面的差异无统计学意义(P = .29):结论:与金标准的钢板固定相比,八字形骨间接线对下颌骨骨折的抗力相当。在资源有限、无法使用钢板和螺钉的情况下,可以考虑使用这种技术实现下颌骨骨折的半刚性固定。
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Craniomaxillofacial Trauma & Reconstruction
Craniomaxillofacial Trauma & Reconstruction DENTISTRY, ORAL SURGERY & MEDICINE-
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