English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Purpose: Mandibular angle fractures are commonly encountered in the maxillofacial field, their surgical treatment includes a wide range of fixation techniques. Herbert cannulated bone screw is a successful minimally invasive mean of fracture fixation that is used routinely in orthopedic surgery. The aim of this study was to evaluate the clinical and radiographic performance of a solitary Herbert bone screw in the treatment of mandibular angle fractures and compare it with the commonly established treatment modality with double 2.0-mm miniplates. Patients and methods: Twenty patients, 15 males and 5 females,with unilateral isolated fracture in the mandibular angle region were selected and randomly allocated into the following groups: group I (n=10) treated with a solitary Herbert Bone Screw and group II (n=10) treated with doubleminiplates. Patients were clinically and radiographically monitored for twelve weeks. Results:The occlusal examination showed a normal occlusion in all of the cases in both groups. Both groups showed a statistically significant gain in the mean bone density across the follow-up period(P<0.001). The difference between groups was statistically insignificant (P=0.761). Conclusions: The utilization of a solitary Herbert cannulated bone screw osteosynthesis provides a successful, more economic, minimally invasive and predictable treatment modality for the treatment of mandibular angle fractures. (196) Haytham Al-Mahalawy E.D.J. Vol. 64, No. 1 of displacement, the direction of the fracture line and vector of muscle pull force3. Owing to the significant possibility of postoperative complication after MAFs management, several treatment modalities were proposedusing various forms of plates and screws systems. However, the choice of one modality over the other depends onseveral diverse variables such as the degree of fragments displacement, fragments comminution, patient age, socioeconomic variables and surgeons experience and preference4. Anabundant amount of discussion has arousedconcerning the most relevant treatment modality for MAFs since the introduction of miniplates into the maxillofacial trauma. Champy et al (1978)5assessed the anatomical and biomechanical consideration for placing miniplates and came out with the concept of ideal lines of osteosynthesis, where the application of these miniplates can be limited to the tension band on the upper border6. However, several authors demonstrate the superiority of double miniplates where they exhibit lower mechanical stresses7-9. Traction osteosynthesis based on axial compression of the bone fragments which was introduced in the maxillofacial region by Brons and Boeringin197010. A recent development was introduced where only a solitary lag screw is used for fixation of MAFs11.This edges plate osteosynthesis in providing more firm fracture stabilization which in turn support rapid primary healing while at the same time reduces the required amount of hardware, tissue exposure and operative time10. Nonetheless,the lag screw spherical head exerts high pressure on a very small area of bone, acting like a wedge, which increases the probability of bone cracking and damage. This may be decreased using a countersink drill, which is difficult to use in the angle region, or combining the screw head with a biconcave washer12,13. To overcome the drawbacks of lag screws, Herbert bone screws (HBS)were introduced as a variation of the traction osteosynthesis modality. Itcontains a differential pitch pattern of threads at both ends of the screw, giving the screw its compressive power. Furthermore, these screws are headless at both ends. The screw design was proposed by Herbert and Fisher in 1984to provide a rigid, safe and minimally invasive alternative that is used in the treatment of fractures of small bones of the hand14. Despite that HBS osteosynthesis was only introduced recently as a new treatment modality for the management of mandibular fractures15,16, the clinical and radiographic behavior of solitary multiplaner HBS in MAFs treatment is insufficiently demonstrated in the contemporary literature. Accordingly, this study was designed to investigate the clinical and radiographic behavior of two different fixation modalities in the management of MAFs, where the outcome of the solitary multiplaner HBS is compared to the commonly utilized two miniplates on the tension and compression bands. PATIENTS AND METHODS A randomized, controlled, parallel-grouped clinical trial was conducted to compare the clinical and radiographic outcomes of solitary HBS and two 2.0-mm miniplates in the management of MAFs. Patientswere selected from the cases admitted to the Emergency Ward of Alexandria University Hospital. Twenty adult patients with no gender predilection diagnosed with recent, uninfected, unilateral, non-comminuted, unfavorable isolated fracture in the angle region that demands open reduction and internal fixation were selected. Subjects with infected fracture lines, concomitant mandibular or other facial fractures, or a systemic disease that could cause interference with the fracture healing were excluded from this study. All participants in this study signed an informed consent before embarking on the surgical operation. HBS VERSUS MINIPLATES IN THE TREATMENT OF MAF (197) According to the type of the utilized fixation device, the patients were randomly allocated into two groups. Patients in group I were treated using a solitary 2.3-mm HBS.Onthe other hand, two parallel miniplates with 2.0-mm monocortical screws were used to manage patients in group II. Both fixation devices were from the same manufacturer (JEIL Medical Corporation Company: Seoul, Korea). The utilized HBS had a shaft diameter of 1.25 mm, a cortical end diameter of 2.3 mm and a 2.0 cancellousend. The HBS kit comes with variable screw lengths, ranging from 10 to 30 mm. The chosen length varied according to the case, and it was determined using KirschnerGuidewire (K-wire). A detailed history taking and a thorough clinical examination were performed and recorded for every patient. A preoperative computerized tomogram (CT) scan (Ingenuity Core; Philips Medical Systems, Cleveland, OH) was obtained to show the extent of fracture line, the degree and direction of displacement, and the relation of teeth involved in the fracture line. All patients received intravenous preoperative prophylactic antibiotic Amoxicillin 1000 mg + Clavulanic acid 200 mg (Augmentin 1.2 g; GlaxoSmithKline, UK). After fracture exposure, a 0.8mm K-Guide Wirewas placedperpendicular to and at least 1 cm away from the fracture line. The depth of the K-wire was measured using a depth gauge to determine the length of the screw to be utilized. A 2mm cannulated spiral drill was used under the guidance of the K-Guide to make the osteotomy, followed by HBS placement, with the aid of the cannulated torque shank screwdriver (Figure 1). For patients in group II, two miniplates were contoured, applied and fixed using 2.0-mm monocortical screws, where a minimum of two screws were placed on either side of the fracture line. At the end of surgery, the temporary IMF was released, the occlusion was checked and the surgical wound was sutured in layers. All patients received postoperative antibiotics in the form of Amoxicillin 500 mg + Clavulanic acid 125 mg (Augmentin 625 mg; GlaxoSmithKline, UK) orally three times per day for 5 days after discharge. Postoperative assessment A postoperative clinical evaluation was performed to observe any complications, which were classified into minor complications as Wound dehiscence, infection, and malocclusion, andmajor complications, as delayed union, non-union, sever interfragmentary mobility. The follow-up sessions were set after 1 week, 4 weeks, 6 weeks and 12weeks. Radiographicappraisal was conducted using an immediate postoperative panoramic x-ray, followed by athree months CT-scanto show fracture healing and for radiodensitometric estimate of the mean bone density at the fracture line in comparison with the preoperative scan. A region of interest (ROI) around the fracture line was used to get the mean bone density using the CT-scan software. All the measurements were in Hounsfield Units (HU)17. Statistical analysis All of the recorded data were documented, tabulated and statistically analyzed utilizing the IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp).Differences between groups were analyzed and the significance of the obtained results was set at the 5% level.

Herbert cannulated bone screw osteosynthesis versus miniplates osteosynthesis in the treatment of mandibular angle fractures