D. Prakash, Vijay Ebenezer* and R. Balakrishnan

Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Bharath University, Chennai - 600 100, India.

DOI : https://dx.doi.org/10.13005/bpj/485

Abstract

The aim of internal fixation of skeletal fracture is to achieve undisturbed fracture healing. The need for plates and screws for fixation is only temporary, until the fracture has united. The surgeons usually recommend to remove the metal plates and screws depending upon the symptoms of the patient post operatively. The use of biologically inert resorbable implants would eliminate the need for a second operation for their removal and offers major clinical advantages for the fixation of facial bone fractures in trauma and orthognathic surgery. This article gives a review of the advantages of the resorbable plates over the conventional metal plates in the management of fractures in maxillofacial surgery.

Keywords

Resorbable Plates; Fractures; Maxillofacial Surgeries

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Copy the following to cite this article: Prakash D, Ebenezer V, Balakrishnan R. Role of Resorbable Plates in The Management of Fractures in Maxillofacial Surgeries. Biomed Pharmacol J 2014;7(1)

Copy the following to cite this URL: Prakash D, Ebenezer V, Balakrishnan R. Role of Resorbable Plates in The Management of Fractures in Maxillofacial Surgeries. Biomed Pharmacol J 2014;7(1). Available from: http://biomedpharmajournal.org/?p=2950

Introduction

The primary goal of fracture management is restoration of healing  of fractured bone resulting in restoration of form and function. Malunion, soft tissue breakdown with miniminal infection should be included in the overall management of fractures. Various bone fixation materials have been used in maxillofacial surgery. Recently“Resorbable Plates & Screw” system have attracted attention as an efficient fixation system  over the conventional techniques such as fixation with wires and metal-plating system(Francel TJ, et al) due to its advantages such as biocompatibility, adequate biomechanical resistance, longer dwelling time, elimination through physiological routes without causing any foreign body reaction.

History

Resorbable plating system were first used as hemostatic vascular clips or surgical suture material (Eppley BL, Sadove AM, et al:) in 1960. Fabrication of implants was accomplished by melt moulding and extrusion of polymer into pins and rods. Subsequently more complex designs such as screws and small plates became possible in the late 1970s and early 1980s (Böstman, 1991).

Chemical composition of Absorbable Implants

They are polymeres consisting of varying compositions of polylactic acid and polyglicolic acid copolymers.(Gosain AK, Song L, Corrao MA, et al:). Many problems such as foreign body reaction, persistence in the body for a longer time have been encountered in the early period of evolution (Bergsma EJ, Rozena FR, Nakamura T, Tajima O, et al;) whic was due to high molecular weight polylactic acid.

Through rapid development of polymer technology the current materials available are  highly biocompatible, and have adequate biomechanical resistance due to which they get eliminated without any foreign body reaction in the body(Eppley BL, Salyer KE, et al;)

The alterations in the polylactic acid /polyglicolic acid ratio also has changed the dwelling time in the body and the rate of biomechanical resistance (peltoniem HH, Tulamo RM, et al;).

Mechanism Of Resorption Of The Resorbable Plates

Resorbable plates and screws gets completely excreted through physiological routes. Resorbable plates are composed of alpha hydroxy  acid polymer which breakdown through hydrolization and their end products are carbondioxide and water(Eppley BL, Sadove AM, et al;).

The degradation of polylactic acid polymers is quite slow owing to their hydrophobic semi crystalline structure. Conversely, polyglycolic

acid polymers have a rapid degradation process due to their highly amorphous structure and increased hydrolytic activities(Bos RR, Boering G, et al;).

Discussion

Turvey TA, Bell RB, Tejera TJ, et al.  Stated that resorbable plates have been used as fixation materials in craniomaxillofacial surgery and for rigid fixation in orthognathic  surgery.

Titanium plates used  for rigid fixation of mandibular fractures allowed  the patient to achieve a normal diet and functions of mandible  earlier than those patients treated with closed reduction and a period of intermaxillary fixation. This avoids hypomobility secondary to prolonged intermaxillary fixation. Also rigid fixation is believed to result in faster bone repair caused by compression of the fracture segments and lack of mobility between the fracture segments(Gabriella MA, Marcantonio E, Cawood JI, et al;)

The disadvantage of a titanium plate over the resorbable plates was that , there were possibilities of removal of plates due to infection which required a second surgery for the patients. But there were no necessary to remove the resorbable plates .

The use of resorbable plates in the management of maxillofacial surgeries was first reported in the literature by Kulkarni et al in 1971( Kulkarni RK, Moore EG, Hegyela AF et, al).

Pilot studies was conducted in the early 1970s which concluded that the use of resorbable plates  and screws were not mechanically adequate without intermaxillary and was excessive in thickness for the use in craniofacial surgeries(Cutright DE , Getter  L, etal,)

Gerlach KL  was the first person to give reference to the fixation of zygomatic fractures with melt- molded poly L lactic acid plates and screws.

Later in 1997 poly L lactic acid  miniplate fixation system for facial fractures was introduced by Bessho et al.

Self-reinforced PLA miniplates was also been described by Haers et al.

The main advantage of  the resorbable plate is that it provides proper strength when needed and then degrades over time without any reaction to the body.

Kim YK, Ylikontiola L et al have described that resorbable plates have reached to a point where their physical properties are sufficient to withstand the postoperative loads required for fracture repair.

Conclusion  

The  use of resorbable plates is more safe than that of conventional mini plates. The resorbable plates have a major advantage of self resorption due to their polymer composition Poly glycolic acid and poly lactic acid. Miniplates are present in the fracture site for life long due to which it gets infected in few patients, but resorbable plates resorbs over a period of time,    Due to which there is no need of second surgery for removal of plates.

References

1. Ellis E, Moos KF, El-Attar A: Ten years of mandibular fractures: An analysis of 2,137 cases. Oral Surg 59:120, 1985 Turvey TA, Bell RB, Tejera TJ, et al: The use of self reinforced biodegradable bone plates and screws in orthognathic surgery. J Oral Maxillofac Surg 60:59, 2002.
2. Kuriakose MA, Fardy M, Sirikumara M, et al: Comparative review of 266 mandibular fractures with internal fixation using rigid (AO/ASIF) plates and miniplates. Br J Oral Maxillofac Surg 34:315, 1996.
3. Gabriella MA, Gabriella MF, Marcantonio E, et al: Fixation of mandibular fractures with 2.0-mm miniplates: Review of 191 cases. J Oral Maxillofac Surg 61:430, 2003.
4. Ellis E, Walker LR: Treatment of mandibular angle fractures using two noncompression miniplate. J Oral Maxillofac Surg 52:1032, 1994.
5. Ellis E, Walker LR: Treatment of mandibular angle fractures using one noncompression miniplate. J Oral Maxillofac Surg 54:864, 1996.
6. Kulkarni RK, Moore EG, Hegyeli AF, et al: Biodegradable poly (lactic acid) polymers. J Biomed Mater Res 5:169, 1971.
7. Cutright DE, Hunsuck E: The repair of fractures of the orbital floor using biodegradeable polylactic acid. Oral Surg Oral Med Oral Pathol 33:28, 1972.
8. Gerlach KL: Treatment of zygomatic fractures with biodegradeable poly L-lactide plates and screws. Clinical implant materials, in Heimke G, Soltesz U, Lee ACJ (eds): Advances in Biomaterials. Amsterdam, Elsevier Science 9:573, 1990.
9. Bessho K, Iizuka T, Murakamj KJ: A bioabsorbable poly lactide miniplate and screw system for osteosynthesis in oral and maxillofacial surgery. J Oral Maxillofac Surg 55:941, 1997.
10. Haers P, Suuronen R, Linqvist C, et al: Biodegradable polylactide plates and screws in orthognathic surgery: Technical note. J Craniomaxillofac Surg 26:87, 1998.
11. Resorbable Plates for the Fixation of Mandibular Fractures: A Prospective Study Robert M. Laughlin, DMD,* Michael S. Block, DMD,† Randall Wilk, DDS, PhD, MD,‡ Randolph B. Malloy, DDS, PhD,§ and John N. Kent, DDS_© 2007 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 65:89-96, 2007.
12. Francel TJ, Bireley BC, Ringelman PR, et al: The fate of plates and screws after facial fracture reconstruction. Plast Reconstr Surg. 1992; 90(4): 568-73.
13. Eppley BL, Sadove AM and Havlik RJ: Resorbable plate fixation in pediatric craniofacial surgery. Plast Reconstr Surg. 1997; 100(1): 1-13.
14. Bergsma EJ, Rozema FR, Bos RR, et al: Foreign body reactions to resorbable poly (L-lactide) bone plates and screws used for the fixation of unstable zygomatic fractures. J Oral Maxillofac Surg. 1993; 51(6): 666-70.
15. Nakamura T, Saki N, Tajima O, et al: Tumorigenicity of poly-L-lactide (PLLA) plates compared with medicalgrade polyethylene. J Biomed Mater Res.1994; 28(1): 17-25.
16. Eppley BL and Sadove AM: A comparison of resorbable and metallic fixation in healing of calvarial bone grafts. Plast Reconstr Surg. 1995; 96(2): 316-22.
17. Eppley BL and Sadove AM: Resorbable coupling fixation in craniosynostosis surgery: Experimental and clinical results. J Craniofac Surg. 1995; 6(6): 477-82.
18. Eppley BL and Sadove AM: Effects of resorbable fixation on craniofacial skletal growth: Modifications in plate size. J Craniofac Surg.1994; 5(2): 110-4; discussion 115.
19. Salyer KE, Bardach J,Savier CA, et al: A comparative study of the effects of biodegradable and titanyum plating systems on cranial growth and structure: Experimental study in beagles. Plast Reconstr Surg. 1994; 93(4): 705-13.
20. Eppley BL, Reilly M: Degradation characteristics of PLLA-PGA bone fixation devices. J Craniofac Surg. 1997; 8(2): 116-2012 Bos RR, Boering G, Rozema FR, et al: Resorbable poly(L-lactide) plates and screws for fixation of zygomatic fractures. J Oral Maxillofac Surg. 1987; 45(9): 751-753.

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