title: Clinical implementation of a multidirectional, angular stable osteosynthesis system in maxillofacial traumatology.
abstract: OBJECTIVE
  To investigate whether a multidirectional, angular stable osteosynthesis system is suitable for the treatment of mandibular fractures and to compare it with well established available systems.
  
  
  METHODS
  Following preliminary testing in an animal model, the multidirectional angular stable system TiFix 2.3 obtained from Litos (Hamburg, Germany) was utilised for internal fixation of 39 mandibular fractures. These involved four symphyseal fractures, 17 parasymphyseal, 16 of the angle of the mandible and two comminuted fractures. The surgical and postoperative course was closely scrutinised. Radiographs were taken after 6 months and all plates removed under local anaesthesia. Photographs were taken intraoperatively and the plates and surrounding soft tissues were salvaged for histological analysis. Additionally, these operations were compared with treatment of equivalent fractures which were treated with conventional, non-angular stable systems. The relative costs have also been evaluated.
  
  
  RESULTS
  In 33 of the 39 fractures one TiFix plate sufficed for osteosynthesis. The plate most often used was a 2-hole plate which was applied in 25 (55.5%) fractures, followed by the 4-hole plates used in 16 (35.5%) fractures. In two comminuted fractures, four 6-hole plates were used (9%). In 17 patients the operation lasted less than 30 min, in 20 patients less than 60 min, in two less than 120 min. In all cases, the operations were shorter, and due to the plates' dimensions fewer screws had to be used, thus reducing the costs.
  
  
  CONCLUSIONS
  This angular stable system enabled reduction of the amount of the implant material. Also reduced were the operation time and the cost of the procedure. Furthermore, in the future it will allow smaller access incisions and better preservation of the soft tissue integrity.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. R. Schmelzle), University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: gbara@web.de.
authors.forename: Ali
authors.initials: A
authors.lastname: Gbara
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. R. Schmelzle), University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. R. Schmelzle), University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzle
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. R. Schmelzle), University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Blake
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000497:Alloys; D001860:Bone Plates / Q000191:economics; D001863:Bone Screws / Q000191:economics; D003365:Costs and Cost Analysis; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000191:economics / Q000295:instrumentation*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery; D008337:Mandibular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010781:Photography; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D014025:Titanium
chemical_list: D000497:Alloys; D014025:Titanium