[Small fragment screws vs. plate osteosynthesis in condylar head fractures].
OBJECTIVE
This prospective study evaluates the outcome after osteosynthesis of condylar head fractures using 1.7 mm small fragment screws (2/2000 ff), which were selected according to a previous biomechanical trial to optimize condylar head traumatology. Clinical and functional results were compared to a group of fractures fixed mainly by mini- and microplates (1993-2000) and to a control group after conservative therapy with early functional training.


METHODS
Functional values (axiography and MRI) regarding loss of vertical height, disk mobility, protrusive and translatory movements were assessed (a) in 34 of 83 condylar head fractures (groups V and VI according to Spiessl and Schroll, 22/69 subjects) managed by osteosynthesis with 1.7-mm small fragment screws (KFS), (b) a reference group (43/84 subjects) fixed mainly by mini- or microplates (PLO), comprising 56 of 101 fractures (1993-2000), and (c) 16 condylar head fractures after conservative therapy with early functional training (KT) as a control.


RESULTS
In cases of small fragment screws, loss of vertical height (0.3 mm) was significantly reduced (p<0.01) in comparison to PLO (1.6 mm) and KT (6.9 mm). Disk mobility in KFS reached 90% of the non-fractured sides (NFS), thus clearly superior (p<0.01) to PLO (63% of NFS) and KT (40% of NFS). Translatory movements after KFS showed better results, too (p<0.05), with mediotrusion 84% and protrusion 80% of NFS. After PLO, mediotrusion was 62%, protrusion 71% of NFS, whereas KT showed only 53% (mediotrusion) and 56% (protrusion) of NFS. High-grade limitations of translatory movements presented in about 30% after PLO and <10% in KFS (p<0.01). Fragment displacements were found in <5% after small fragment screws, and in the plate osteosynthesis group in 15% (p<0.01).


CONCLUSIONS
Due to better stability and reduced articular scarification osteosynthesis with 1.7-mm small fragment screws in condylar head fractures showed clearly superior functional results compared to mini- and microplates, and to conservative therapy.
Neff
A
A
Klinik und Poliklinik für Mund-Kiefer-Gesichtschirurgie der Technischen Universität München, Klinikum rechts der Isar, 81675 München. A.Neff@lrz.tu-muenchen.de
Kolk
A
A
Meschke
F
F
Deppe
H
H
Horch
H-H
HH
D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007574:Jaw Relation Record; D004204:Joint Dislocations / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D008904:Miniaturization; D011183:Postoperative Complications / Q000175:diagnosis*; D013704:Temporomandibular Joint / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed