Dental and Medical Problems

Dent Med Probl
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Dental and Medical Problems

2017, vol. 54, nr 3, July-September, p. 223–228

doi: 10.17219/dmp/75907

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Treatment of high fracture of the neck of the mandibular condylar process by rigid fixation performed by lag screws: Finite element analysis

Leczenie wysokiego złamania szyjki wyrostka kłykciowego żuchwy poprzez sztywne unieruchomienie śrubami – analiza z wykorzystaniem elementów skończonych

Marcin Kozakiewicz1,A,C,D,E,F, Jacek Świniarski2,A,B,C,E,F

1 Department of Maxillofacial Surgery, Medical University of Lodz, Łódź, Poland

2 Department of Strength of Materials and Structures, Technical University of Lodz, Łódź, Poland

Abstract

Background. From 1 to 4 fixing screws can be used clinically for rigid fixation of a mandibular condyle fracture, but contrarily, there is an opinion that insertion of even 3 screws in this region is technically impossible. On the other hand, the application of a single screw is the simplest technique. But if it is rigid?
Objectives. Evaluation of the rigidity of titanium lag screw fixation in a mandible high condyle neck fracture.
Material and Methods. A numerical analysis was performed using a model of a high condylar neck fracture. Fixation by 1, 2 or 3 lag screws were tested. The equivalent stress (S) distribution and displacement (D) of the fracture fragments were calculated.
Results. S = 464 MPa in 1-screw fixation and was spread widely in the condylar head (137 MPa) and downward in the distal mandibular fragment. In the 2-screw fixation, the anterior screw was more stressed (S = 319 MPa). Stress concentration in the condylar head was observed around the anterior screw (211 MPa) and spread toward the sigmoid notch in the distal bone fragment. The best biomechanical situation was in the 3-screw fixation (S = 222 MPa). The area of stress in the condylar head was limited and low (108 MPa), and the distribution of equivalent stress in the rest of the mandible was close to normal during mastication. Normal bone elasticity presented in the condyle neck was 9.6 ±3.7 μm during the occlusal load. In 1 screw D = 558 ±245 μm, for 2 screws D = 218 ±81 μm, and for the 3-screw fixation D = 217 ±144 μm. Two and 3 screw fixations were statistically better than the 1 screw rigid fixation (p < 0.001).
Conclusion. Open fixation by two 2.0 mm diameter lag screws is sufficiently rigid. The use of more screws seems to be unnecessary.

Key words

fracture, lag screw, mandibular condyle, rigid fixation

Słowa kluczowe

złamanie, śruba, wyrostek kłykciowy żuchwy, unieruchomienie sztywne

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