Comparative Study of Intra Osseous Wiring, Miniplate Osteosynthesis and Reconstruction Plate With Bone Graft in the Method of Treatment for Mandibular Fracture

Abstract

The mandible or lower jaw is one of the most commonly encountered maxillo facial fractures in our clinical practice. Un-displaced, single and closed fractures are usually managed by closed method with maxillo-mandibular fixation (MMF). Displaced open and multiple fractures are treated by open reduction and internal fixation (ORIF). Displaced, open and multiple fractures are treated by ORIF by various methods like intraosseus wiring, miniplate osteosynthesis and reconstruction plate with bone graft. Present study is done to evaluate these three methods of ORIF and their post-operative outcome. Our study material comprises 72 cases of isolated mandibular fracture of adult patient. All these patients are treated by ORIF by either of the three above methods. These patients are divided into three groups. Group A includes 18 cases treated by intra osseous wiring and post-operative maxillo mandibular immobilization for 4 weeks. Group B includes 38 cases treated with single or double miniplate and no post-operative immobilization. Group C includes 11 cases treated by reconstruction plate with bone graft along with miniplate in patients having bone loss or gap fractures. The surgical outcome based on parameters such as malocclusion, intra oral exposure of plate, wound dehiscence, delayed union, plate fracture, nonunion and sensory deficit are compared at 4-6 weeks after operation among the three groups and patients are followed up every three months interval. The results are statistically analysed and it is concluded that the use of miniplate gives better result in comparison to intra osseous wiring. In cases of bone loss or gap fracture reconstruction plate and bone graft along with miniplate are effective.