Osteosynthesis using cannulated headless Herbert screws in mandibular angle fracture treatment: A new approach?

Introduction: Fractures of the mandibular angle are a common type of facial skull fracture. Although operative treatment includes a wide range of fixation techniques, a definite gold standard method has yet to be established. Headless, cannulated Herbert screws, often used in many forms of minimally invasive trauma surgery, provide functional and stable fracture fixation. Materials and methods: In a prospective, double-randomised, controlled, parallel-group designed, in vitro trial, the biomechanical behaviour of the Herbert bone screw system was compared to that of a conventional locking plate system in 40 mandibular angle fractures of human mandible cadaver phantoms. Results: The mean stress values were 250 (+/- 68.0) N in the plate subgroup and 200 (+/- 61.0) N in the screw subgroup. The respective mean strain values were 7.90 (+/- 2.7) mm and 6.90 (+/- 2.2) mm, and the respective mean stiffness were values 1.10 (+/- 0.61) N/m and 0.78 (+/- 0.40) N/m. The differences in the results obtained using the two treatments were not significant (p = 0.55). Conclusions: The biomechanical behaviour of the two fixation systems within the tested loads did not significantly differ with respect to postoperative parameters clinically relevant in osteosynthesis. Both systems met the mandibular angle assessment criterion, which is considered to be sufficient for clinical use. The results indicate the potential clinical utility of these two systems, and recommend further testing. (C) 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.