Indications and limitations in resorbable P(L70/30DL)LA osteosyntheses of displaced mandibular fractures in 4.5-year follow-up.

BACKGROUND

This study evaluates prospective 4.5-year follow-up of available poly(l-lactide-co-dl-lactide) [P(L70/30DL)LA] resorbable plate osteosyntheses in displaced traumatic and pathological mandibular fractures.

METHODS

P(L70/30DL)LA miniplates and screws were used to fixate 50 displaced fractures in 30 patients, aged 1 to 83 years, with their informed consent. There were 15 traumatic paramedian, seven corpus, 11 angle, and 10 condyle fractures, and seven pathological fractures due to atrophy, osteomyelitis, or third molar osteotomy. Double osteosyntheses were preferred, with one monocortical plate at the dentoalveolar basis (6-mm screws) and a second plate at the inferior margin (8-mm screws).

RESULTS

The average follow-up was 31 months (range, 6 to 53 months). Fifteen (100 percent) traumatic paramedian, seven (100 percent) corpus, 10 (91 percent) angle, 10 (100 percent) condylar, and three (43 percent) pathological fractures healed primarily. Two mandibular angle fractures, traumatic and pathological, each initially healed, but 6 weeks postoperatively the first fracture re-dislocated on removal of a dental impression by the family dentist, and the second re-dislocated after mastication of hard food. One atrophic corpus fracture developed a rigid fibrous union in an 83-year-old patient; a preexistent osteomyelitis and fracture progressed to further bone loss and finally required preformed fibula reconstruction.

CONCLUSIONS

Use of the tested resorbable plates can be encouraged in multiple displaced mandibular fractures in children and likewise in highly compliant dentate adolescents and adults with doubled osteosyntheses; traumatic mandibular angle and pathological fractures, however, remain critical for nonunion. These necessitate evaluation with future smaller, more rigid, and, it is hoped, more economical fixations.