Evaluation of the Relationship of Screw Pullout and Plate Fracutre in Fixation of Mandible Condyle Fractures: A Mechanistic Study

Background: The mandible is the most injured part of the facial skeleton, and 25-40% of mandibular fractures involve the condyle process. The aim of this study is to answer the question of the relationship between screw pullout and/or plate fracture during osteosynthesis. Methods: We tested polyurethane models of mandibles whose condylar process was cut (simulating a fracture) and fused using plates and screws. Results: A total of 672 plates were tested. A total of 25.6% of them were fractured during the test, with most being fractures of the base of the condyle. More screws (81.97%) are pulled out from the ramus than from the condyle-69.15%. Conclusions: The gold standard in the osteosynthesis of condylar fractures is two straight plates. Other than these, there is no one-size-fits-all plate for every type of fracture. Plates fixed with fewer screws (smaller plates used in higher-lying fractures) are more likely to result in screw pullout. On the other hand, in plates fixed with more screws, plate fracture is more common.

Automated summary

This study examined the relationship between screw pullout and/or plate fracture during mandibular osteosynthesis. Results showed that 25.6% of the tested plates experienced fractures, with the majority occurring at the base of the condyle. More screws were pulled out from the ramus (81.97%) compared to the condyle (69.15%). The gold standard for treating condylar fractures is the use of two straight plates, but there is no universally applicable plate for every fracture type. Plates fixed with fewer screws (smaller plates for higher-lying fractures) are more likely to result in screw pullout, while plates fixed with more screws are more prone to plate fracture.