Evaluation of a Vertical Box Plating Technique for Mandibular Body Fractures and Retrospective Analysis of Patient Outcomes

Daniel Demesh, James A. Leonard, Clyde B. Schechter, Prince Dhillon, Wayne Hsueh, Howard Stupak

Research output: Contribution to journalArticle

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Abstract

Importance: Despite advancements, treatment of mandibular body fractures is plagued by complications. Evaluation of a new plating system is needed with the goal of reducing complication rates. Objectives: To evaluate the biomechanical behavior of a vertically oriented box plate vs traditional rigid internal fixation plating techniques for mandibular body fractures and to test if placement of the 3-dimensional plate oriented parallel to the fracture line provides improved rigidity and greater resistance to torsion, resulting in improved outcomes. Design, Setting, and Participants: A mandible fracture model with synthetic replicas was used to compare resistance to torsional forces of different plating configurations. Additionally, a retrospective comparative review of the medical records of 84 patients with mandibular body fractures treated from 2005 to 2018 at Jacobi Medical Center, a level-1 trauma hospital in Bronx, New York, was completed. Exposures: Patients sustained a mandibular body fracture and were treated with open reduction and internal fixation using metal plating. Main Outcomes and Measures: In the comparative study of biomechanical behavior of various plating configurations, maximum torque sustained prior to deformation and loss of alignment was measured. Medical records were reviewed for surgical approach, plating techniques, operative time, length of admission, and rate of complications, including malocclusion, nonunion, infection, neurosensory disturbance, and wound dehiscence. Results: Of the 84 patients included in the retrospective review, 76 (91%) were men, and the mean (SD) age was 29.7 (12.0) years. During biomechanical analysis, the vertical box plate provided greater stability and 150% of the resistance against torsional forces when compared with traditional linear plating. In the retrospective review, analysis showed vertical plating was associated with a lower incidence of postoperative neurosensory disturbance (25 [38%] patients treated with vertical plating vs 0 patients treated with box plating; P =.002) and a lower risk of any complication (41 [62%] vs 6 [33%], respectively; relative risk, 0.54; 95% CI, 0.27-1.06; P =.03). Vertical plating was associated with reduced operative time (134 minutes vs 70 minutes, respectively; P <.001). Conclusions and Relevance: This investigation suggests that vertical box plating is associated with a lower incidence of postoperative complications and reduced operative time compared with traditional plating techniques. The comparative biomechanical component demonstrated that the vertical box plate offered equal or greater resistance to torsional forces. Further studies of greater power and level of evidence are needed to more robustly demonstrate these benefits. Level of Evidence: 3..

Original languageEnglish (US)
JournalJAMA Facial Plastic Surgery
DOIs
StatePublished - Jan 1 2019

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Mandibular Fractures
Mechanical Torsion
Operative Time
Medical Records
Electroplating
Malocclusion
Incidence
Wounds and Injuries
Torque
Mandible
Outcome Assessment (Health Care)
Infection

ASJC Scopus subject areas

  • Surgery

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Evaluation of a Vertical Box Plating Technique for Mandibular Body Fractures and Retrospective Analysis of Patient Outcomes. / Demesh, Daniel; Leonard, James A.; Schechter, Clyde B.; Dhillon, Prince; Hsueh, Wayne; Stupak, Howard.

In: JAMA Facial Plastic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Evaluation of a Vertical Box Plating Technique for Mandibular Body Fractures and Retrospective Analysis of Patient Outcomes",
abstract = "Importance: Despite advancements, treatment of mandibular body fractures is plagued by complications. Evaluation of a new plating system is needed with the goal of reducing complication rates. Objectives: To evaluate the biomechanical behavior of a vertically oriented box plate vs traditional rigid internal fixation plating techniques for mandibular body fractures and to test if placement of the 3-dimensional plate oriented parallel to the fracture line provides improved rigidity and greater resistance to torsion, resulting in improved outcomes. Design, Setting, and Participants: A mandible fracture model with synthetic replicas was used to compare resistance to torsional forces of different plating configurations. Additionally, a retrospective comparative review of the medical records of 84 patients with mandibular body fractures treated from 2005 to 2018 at Jacobi Medical Center, a level-1 trauma hospital in Bronx, New York, was completed. Exposures: Patients sustained a mandibular body fracture and were treated with open reduction and internal fixation using metal plating. Main Outcomes and Measures: In the comparative study of biomechanical behavior of various plating configurations, maximum torque sustained prior to deformation and loss of alignment was measured. Medical records were reviewed for surgical approach, plating techniques, operative time, length of admission, and rate of complications, including malocclusion, nonunion, infection, neurosensory disturbance, and wound dehiscence. Results: Of the 84 patients included in the retrospective review, 76 (91{\%}) were men, and the mean (SD) age was 29.7 (12.0) years. During biomechanical analysis, the vertical box plate provided greater stability and 150{\%} of the resistance against torsional forces when compared with traditional linear plating. In the retrospective review, analysis showed vertical plating was associated with a lower incidence of postoperative neurosensory disturbance (25 [38{\%}] patients treated with vertical plating vs 0 patients treated with box plating; P =.002) and a lower risk of any complication (41 [62{\%}] vs 6 [33{\%}], respectively; relative risk, 0.54; 95{\%} CI, 0.27-1.06; P =.03). Vertical plating was associated with reduced operative time (134 minutes vs 70 minutes, respectively; P <.001). Conclusions and Relevance: This investigation suggests that vertical box plating is associated with a lower incidence of postoperative complications and reduced operative time compared with traditional plating techniques. The comparative biomechanical component demonstrated that the vertical box plate offered equal or greater resistance to torsional forces. Further studies of greater power and level of evidence are needed to more robustly demonstrate these benefits. Level of Evidence: 3..",
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AU - Demesh, Daniel

AU - Leonard, James A.

AU - Schechter, Clyde B.

AU - Dhillon, Prince

AU - Hsueh, Wayne

AU - Stupak, Howard

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N2 - Importance: Despite advancements, treatment of mandibular body fractures is plagued by complications. Evaluation of a new plating system is needed with the goal of reducing complication rates. Objectives: To evaluate the biomechanical behavior of a vertically oriented box plate vs traditional rigid internal fixation plating techniques for mandibular body fractures and to test if placement of the 3-dimensional plate oriented parallel to the fracture line provides improved rigidity and greater resistance to torsion, resulting in improved outcomes. Design, Setting, and Participants: A mandible fracture model with synthetic replicas was used to compare resistance to torsional forces of different plating configurations. Additionally, a retrospective comparative review of the medical records of 84 patients with mandibular body fractures treated from 2005 to 2018 at Jacobi Medical Center, a level-1 trauma hospital in Bronx, New York, was completed. Exposures: Patients sustained a mandibular body fracture and were treated with open reduction and internal fixation using metal plating. Main Outcomes and Measures: In the comparative study of biomechanical behavior of various plating configurations, maximum torque sustained prior to deformation and loss of alignment was measured. Medical records were reviewed for surgical approach, plating techniques, operative time, length of admission, and rate of complications, including malocclusion, nonunion, infection, neurosensory disturbance, and wound dehiscence. Results: Of the 84 patients included in the retrospective review, 76 (91%) were men, and the mean (SD) age was 29.7 (12.0) years. During biomechanical analysis, the vertical box plate provided greater stability and 150% of the resistance against torsional forces when compared with traditional linear plating. In the retrospective review, analysis showed vertical plating was associated with a lower incidence of postoperative neurosensory disturbance (25 [38%] patients treated with vertical plating vs 0 patients treated with box plating; P =.002) and a lower risk of any complication (41 [62%] vs 6 [33%], respectively; relative risk, 0.54; 95% CI, 0.27-1.06; P =.03). Vertical plating was associated with reduced operative time (134 minutes vs 70 minutes, respectively; P <.001). Conclusions and Relevance: This investigation suggests that vertical box plating is associated with a lower incidence of postoperative complications and reduced operative time compared with traditional plating techniques. The comparative biomechanical component demonstrated that the vertical box plate offered equal or greater resistance to torsional forces. Further studies of greater power and level of evidence are needed to more robustly demonstrate these benefits. Level of Evidence: 3..

AB - Importance: Despite advancements, treatment of mandibular body fractures is plagued by complications. Evaluation of a new plating system is needed with the goal of reducing complication rates. Objectives: To evaluate the biomechanical behavior of a vertically oriented box plate vs traditional rigid internal fixation plating techniques for mandibular body fractures and to test if placement of the 3-dimensional plate oriented parallel to the fracture line provides improved rigidity and greater resistance to torsion, resulting in improved outcomes. Design, Setting, and Participants: A mandible fracture model with synthetic replicas was used to compare resistance to torsional forces of different plating configurations. Additionally, a retrospective comparative review of the medical records of 84 patients with mandibular body fractures treated from 2005 to 2018 at Jacobi Medical Center, a level-1 trauma hospital in Bronx, New York, was completed. Exposures: Patients sustained a mandibular body fracture and were treated with open reduction and internal fixation using metal plating. Main Outcomes and Measures: In the comparative study of biomechanical behavior of various plating configurations, maximum torque sustained prior to deformation and loss of alignment was measured. Medical records were reviewed for surgical approach, plating techniques, operative time, length of admission, and rate of complications, including malocclusion, nonunion, infection, neurosensory disturbance, and wound dehiscence. Results: Of the 84 patients included in the retrospective review, 76 (91%) were men, and the mean (SD) age was 29.7 (12.0) years. During biomechanical analysis, the vertical box plate provided greater stability and 150% of the resistance against torsional forces when compared with traditional linear plating. In the retrospective review, analysis showed vertical plating was associated with a lower incidence of postoperative neurosensory disturbance (25 [38%] patients treated with vertical plating vs 0 patients treated with box plating; P =.002) and a lower risk of any complication (41 [62%] vs 6 [33%], respectively; relative risk, 0.54; 95% CI, 0.27-1.06; P =.03). Vertical plating was associated with reduced operative time (134 minutes vs 70 minutes, respectively; P <.001). Conclusions and Relevance: This investigation suggests that vertical box plating is associated with a lower incidence of postoperative complications and reduced operative time compared with traditional plating techniques. The comparative biomechanical component demonstrated that the vertical box plate offered equal or greater resistance to torsional forces. Further studies of greater power and level of evidence are needed to more robustly demonstrate these benefits. Level of Evidence: 3..

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