Effects of Polymethylmethacrylate on the Stability of Screw Fixation in Mandibular Angle Fractures: A Study on Sheep Mandibles

Overview

Journal Int J Med Sci

Specialty General Medicine

Date 2018 Nov 17

PMID 30443166

Citations 2

Authors

Abdulkadir Burak Cankaya

Metin Berk Kasapoglu

Mehmet Ali Erdem

Cetin Kasapoglu

Affiliations

Soon will be listed here.

Abstract

Malfixed miniplates can impair fracture healing, and the screw pilot holes may widen during repeated fixation trials. This study explored the extent to which screw fixation of mandibular angle fractures could be improved by augmenting the drilling holes with polymethylmethacrylate (PMMA). We measured stabilization by recording specimen displacement under a vertical force of 50 N applied using a hydraulic tester. We included 20 hemimandibles from sheep (average weight 40 kg). The specimens were randomly divided into two groups of 10 and pilot holes were created in the angulus region using a drill 1.2 mm in diameter. Next, we performed osteotomies simulating angulus fracture repair. In group 1, the fracture site was fixed using non-compression miniplates and four screws were inserted to the maximal possible extent employing a mechanical screwdriver. In group 2, the pilot drill holes were filled with PMMA prior to miniplate fixation. Then vertical forces of 50 N were applied to the molar region and the displacements were measured. The Shapiro-Wilks test was used to compare the two groups. The maximum average displacement in the experimental group was significantly lower than that in the control group (p=0.026). Thus, PMMA-augmented screws better stabilized bone, affording reliable fixation.

Citing Articles

Biomechanical Comparison of WE43-Based Magnesium vs. Titanium Miniplates in a Mandible Fracture Model in Sheep.

Fischer H, Schmidt-Bleek O, Orassi V, Wulsten D, Schmidt-Bleek K, Heiland M Materials (Basel). 2023; 16(1).

PMID: 36614440 PMC: 9821048. DOI: 10.3390/ma16010102.

Biological and microbiological behavior of calcium aluminate cement-based blend for filling of bone defects.

de Vasconcellos L, Campores K, de Alcantara Abdala J, Vieira M, de Oliveira I J Mater Sci Mater Med. 2019; 31(1):10.

PMID: 31873807 DOI: 10.1007/s10856-019-6348-1.

References

Wittenberg R, Lee K, Shea M, White 3rd A, Hayes W . Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop Relat Res. 1993; (296):278-87. View

Girardo M, Cinnella P, Gargiulo G, Viglierchio P, Rava A, Aleotti S . Surgical treatment of osteoporotic thoraco-lumbar compressive fractures: the use of pedicle screw with augmentation PMMA. Eur Spine J. 2017; 26(Suppl 4):546-551. DOI: 10.1007/s00586-017-5037-3. View

Gerlach K, Schwarz A . Bite forces in patients after treatment of mandibular angle fractures with miniplate osteosynthesis according to Champy. Int J Oral Maxillofac Surg. 2002; 31(4):345-8. DOI: 10.1054/ijom.2002.0290. View

Yazu M, Kin A, Kosaka R, Kinoshita M, Abe M . Efficacy of novel-concept pedicle screw fixation augmented with calcium phosphate cement in the osteoporotic spine. J Orthop Sci. 2005; 10(1):56-61. DOI: 10.1007/s00776-004-0862-8. View

Haug R, Street C, Goltz M . Does plate adaptation affect stability? A biomechanical comparison of locking and nonlocking plates. J Oral Maxillofac Surg. 2002; 60(11):1319-26. DOI: 10.1053/joms.2002.35732. View

Linhardt O, Luring C, Matussek J, Hamberger C, Plitz W, Grifka J . Stability of pedicle screws after kyphoplasty augmentation: an experimental study to compare transpedicular screw fixation in soft and cured kyphoplasty cement. J Spinal Disord Tech. 2006; 19(2):87-91. DOI: 10.1097/01.bsd.0000177212.52583.bd. View

Braasch D, Abubaker A . Management of mandibular angle fracture. Oral Maxillofac Surg Clin North Am. 2013; 25(4):591-600. DOI: 10.1016/j.coms.2013.07.007. View

Pektas Z, Bayram B, Balcik C, Develi T, Uckan S . Effects of different mandibular fracture patterns on the stability of miniplate screw fixation in angle mandibular fractures. Int J Oral Maxillofac Surg. 2011; 41(3):339-43. DOI: 10.1016/j.ijom.2011.11.008. View

Champy M, Lodde J, Schmitt R, Jaeger J, Muster D . Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg. 1978; 6(1):14-21. DOI: 10.1016/s0301-0503(78)80062-9. View

10.

Renner S, Lim T, Kim W, Katolik L, An H, Andersson G . Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine (Phila Pa 1976). 2004; 29(11):E212-6. DOI: 10.1097/00007632-200406010-00020. View

11.

Chang M, Liu C, Chen T . Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976). 2008; 33(10):E317-24. DOI: 10.1097/BRS.0b013e31816f6c73. View

12.

Champy M, Wilk A, Schnebelen J . [Tretment of mandibular fractures by means of osteosynthesis without intermaxillary immobilization according to F.X. Michelet's technic]. Zahn Mund Kieferheilkd Zentralbl. 1975; 63(4):339-41. View

13.

Hirano T, Hasegawa K, Washio T, Hara T, Takahashi H . Fracture risk during pedicle screw insertion in osteoporotic spine. J Spinal Disord. 1999; 11(6):493-7. View

14.

Poon C, Verco S . Evaluation of fracture healing and subimplant bone response following fixation with a locking miniplate and screw system for mandibular angle fractures in a sheep model. Int J Oral Maxillofac Surg. 2013; 42(6):736-45. DOI: 10.1016/j.ijom.2012.12.009. View

15.

Chuong R, Donoff R, GURALNICK W . A retrospective analysis of 327 mandibular fractures. J Oral Maxillofac Surg. 1983; 41(5):305-9. DOI: 10.1016/0278-2391(83)90297-5. View

16.

Heidemann W, Gerlach K, Grobel K, Kollner H . Influence of different pilot hole sizes on torque measurements and pullout analysis of osteosynthesis screws. J Craniomaxillofac Surg. 1998; 26(1):50-5. DOI: 10.1016/s1010-5182(98)80035-8. View

17.

Kayanja M, Evans K, Milks R, Lieberman I . The mechanics of polymethylmethacrylate augmentation. Clin Orthop Relat Res. 2006; 443:124-30. DOI: 10.1097/01.blo.0000200243.60426.57. View

18.

Barry C, Kearns G . Superior border plating technique in the management of isolated mandibular angle fractures: a retrospective study of 50 consecutive patients. J Oral Maxillofac Surg. 2007; 65(8):1544-9. DOI: 10.1016/j.joms.2006.10.069. View

19.

Aziz S, Ziccardi V, Borah G . Current therapy: complications associated with rigid internal fixation of facial fractures. Compend Contin Educ Dent. 2005; 26(8):565-71. View

20.

Frankel B, Dagostino S, Wang C . A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine. 2007; 7(1):47-53. DOI: 10.3171/SPI-07/07/047. View