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Evaluation of internal fixation techniques for condylar head fractures: A finite element analysis and comparison

  • Author Footnotes
    1 Both are first co-authors.
    Lingtong Bu
    Footnotes
    1 Both are first co-authors.
    Affiliations
    Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
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  • Author Footnotes
    1 Both are first co-authors.
    Qin Chen
    Footnotes
    1 Both are first co-authors.
    Affiliations
    Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
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  • Kai Huang
    Affiliations
    Shenzhen Excellent Technology Company Limited, Shenzhen, Guangdong, China
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  • Xiaowen Zhao
    Affiliations
    Shenzhen Excellent Technology Company Limited, Shenzhen, Guangdong, China
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  • Jisi Zheng
    Correspondence
    Reprint requests: Jisi Zheng, Yating Qiu, and Chi YangShanghai Jiao Tong University School of MedicineDepartment of Oral Surgery639 Zhizaoju RoadShanghaiChina.
    Affiliations
    Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
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  • Yating Qiu
    Correspondence
    Reprint requests: Jisi Zheng, Yating Qiu, and Chi YangShanghai Jiao Tong University School of MedicineDepartment of Oral Surgery639 Zhizaoju RoadShanghaiChina.
    Affiliations
    Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
    Search for articles by this author
  • Chi Yang
    Correspondence
    Reprint requests: Jisi Zheng, Yating Qiu, and Chi YangShanghai Jiao Tong University School of MedicineDepartment of Oral Surgery639 Zhizaoju RoadShanghaiChina.
    Affiliations
    Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    1 Both are first co-authors.
Published:September 05, 2021DOI:https://doi.org/10.1016/j.oooo.2021.08.028

      Objectives

      This study evaluated optimum stability of different screw techniques for condylar head fractures (CHF) (P close to an M fracture with the lateral pole preserved according to AO classification 2014) by finite element analysis (FEA) and provided a biomechanical basis for clinical treatment.

      Study Design

      Four CHF fixation models were evaluated: (A) single bicortical screw, (B) 2 bicortical screws, (C) 1 bicortical screw and 1 monocortical screw (used as a positional screw) inserted via a 2-hole titanium plate, and (D) 2 bicortical screws inserted via a titanium plate. Stresses were calculated (FEA) to measure mechanical properties.

      Results

      The displacement for A and C was larger than for B and D. The maximum stress on the screws for A and C exceeded their breaking limit but was safe for B and D. The stress on the titanium plate for C and D was safe. The stress on bone for A and C was larger than for B and D.

      Conclusions

      The 2 bicortical screw fixation reduced the stress on implanted materials and surrounding bone tissue. Titanium plates further alleviated the lever action. Two bicortical screw fixation was more reliable for CHF, and early postoperative loading and functional training can be expected.
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