______________________________________________________ ORIGINAL ARTICLE

Versatility of locking plates over conventional

miniplates in mandibular fractures

Verma A.1, Sachdeva A.2, Yadav S.3

Abstract:

The objective of the clinical study was to evaluate the efficacy of locking plates and
conventional miniplates in mandibular fractures. The site of fracture, osteosynthesis, post
operative functional ability and complications of fracture after osteosynthesis were evaluated.
21 patients were treated with 2 mm locking miniplates (GroupA) and 22 patients were treated
with 2 mm conventional miniplates (Group B).

Keywords: Locking plates, mandibular fractures

Introduction:

and the Champy method of monocortical

The increasing road traffic
accidents have led to a significant increase
in incidence of maxillofacial trauma.
Fractures of the mandible have been
reported to account for 36-70% of all
maxillofacial fractures[1,2]. All reports
apparently show a higher frequency in males
aged 21-30 years[2]. Other contributing
factors such as socioeconomic status,
environment and alcohol use show greater
variability[3, 4].
Rigid internal fixation is a gold standard for
the treatment of fractures. This technique
was developed and popularized by
Arbeitsgemeinschaft fur
Osteosynthesefragen/Association for the
Study of Internal Fixation (AO/ASIF) in
Europe in 1970s. Champy[5] advocated
transoral placement of small, thin malleable
miniplates with monocortical screws along
an ideal osteosynthesis line of the mandible.
The guidelines of AO rigid internal fixation
miniplates revolutionized the treatment
approach to mandibular fractures.
With the introduction of lockingplates, the
disadvantages of conventional mini plates
have been overcome. In conventional
miniplate system the stability is achieved
when the head of the screw compresses the
fixation plate to the bone as the screw is
tightened. In locking plates the screw locks
not only to the bone but to the bone plate
also. This is accomplished by having a
screw with a double thread. One thread will
engage the bone; another will engage a
threaded area of the bone plate which results
in providing mini-internal fixator.
To evaluate the efficacy, a clinical study was
done to compare effectiveness of 2.0 mm
locking miniplates and screws with 2.0 mm
standard miniplates and screws in treating
mandible fractures.

Correspondence: Dr. Ajay Verma, Reader, Deptt. of Oral & Maxillofacial Surgery, PDM Dental College & Research
Institute, Bahadurgarh-124507, Haryana, India, Email – drajayverma05@yahoo.co.in, Tel. no. +91-9896003101.

1
Reader, 2Lecturer, 3Professor, Deptt. of Oral & Maxillofacial Surgery, PDM Dental College & Research Institute,
Bahadurgarh-124507, Haryana, India

Journal of Innovative Dentistry, Vol 1, Issue1, Jan-April 2011

______________________________________________________ ORIGINAL ARTICLE

Materials and methods: radiograph. A definitive diagnosis of

43 patients with single unilateral fracture of
mandible were operated from June 2008 to
February 2010. Twenty one patients were
treated using 2.0mm locking plates (Group-
A) and another 22 patients were treated
using conventional 2.0mm miniplates
(Group-B). The patients were in the age
group of 20- 65 years (Table 1). A thorough
history was taken and meticulous clinical
examination was performed on all patients.
All subjects who had sustained mandibular
fracture were advised a panoramic
mandibular fracture was established with the
aid of clinical and radiographic findings.
Patients were evaluated for etiological
factors (Table 2), location of the fracture
(Table 3), osteosynthesis, postoperative
occlusion, need for intermaxillary fixation
(IMF) and complications like failure of the
hardware and infection at the fracture site
(Table 4).
All the patients were followed for 12 weeks
postoperatively. The evaluation was done at
1st week, 4th week, 8th week and 3rd month.

Results:
Number
of
Age Number Percentage Site patients Percentage
range of
(Years) patients
Para- 24 55.81%
symphysis
20-30 9 20.93%
Condylar 2 4.65%
30-40 24 55.81% & Sub-
40-50 5 11.63% condylar
50-60 4 9.30% Angle 11 25.58%
60- 65 1 2.33% Symphysis 1 2.33%
Table 1 Age Distribution of Patients Body 5 11.63%
Table 3 Site Distribution
Aetiology Number Percentage
of
cases placement of the fixation hardware.
RTA 33 76.75% Postoperative radiographs taken within the
Fall 4 9.30% first 2 days showed excellent reduction in all
Sports 2 4.65% cases.
Assault 3 6.98%
The need for postoperative IMF was
Hit by 1 2.33%
variable in both groups. In Group A, 2
a Bull
patients required IMF postoperatively while
Table 2 Aetiology of Injuries the number of patients requiring IMF in
Group B was 11. Occlusal discrepancy was
Of the 43 patients, there were 4 females and noticed in a single patient of Group B at the
39 males. The average age was 34.05+ 3.08 third month follow up.
with a range of 22 to 63 years. The main Postoperative infection developed in 4
cause of trauma was road traffic accident in patients; 1 in Group A and 3 in Group B.
about 33 patients. All the patients were Hardware in 2 fractures had to be removed
treated within one week after injury. After in Group B (angle & parasymphysis
application of the bone plates, all fractures region).
appeared to be well reduced and stable (Fig.
1A, 1B, 2A, 2B). There were no
intraoperative difficulties associated with
Journal of Innovative Dentistry, Vol 1, Issue1, Jan-April 2011
______________________________________________________ ORIGINAL ARTICLE

Complications N=21 Percentage N=22 Percentage

(Group A) (Group B)

Infection 1 4.7% 3 13.6%

Occlusal disturbance 0 0 1 4.5%

Total 1 4.7% 4 18.2%

Table 4 Complications (in % of patients)

Both patients had good occlusion and healed

fractures at the time of hardware removal.
The bone plate was found to be loose from
the bone. No such complication was found
in Group A.

Fig 1B Locking plates applied at Sub-

condylar fracture

Fig 1A Fracture at left Subcondylar region.

Fig 2A Fracture at right parasymphysis

region.

Journal of Innovative Dentistry, Vol 1, Issue1, Jan-April 2011

______________________________________________________ ORIGINAL
Fig 2B Locking plates applied at
parasymphysis fracture
Discussion:
Over the past 10 years, there has been an
introduction of locking plate-screw system
into maxillofacial surgery. Conventional
plate-screw system requires precise
adaptation of the plate to the underlying
bone. Without this intimate contact,
tightening of the screws will draw the bone
segments toward the plate, resulting in
alterations in the position of osseous
segments and the occlusal relationship.
Locking plate-screw system offers certain
advantages over other plates in this
regard[6,7].
In the present study of fracture patients, the
age group most commonly affected was 30-
40 years and it was mainly due to road
traffic accidents i.e. 55.8%. The number of
male patients was higher (91%) than that of
female patients (9%), in accordance with the
other studies [1, 2, 8].
One of the interesting finding in our study
was that the postoperative IMF was required
in fewer cases in Group A. But this finding
alone cannot prove the higher stability of
locking plate system. The severity of
displacement of fracture segments and
precise anatomical reduction achieved
should be taken into consideration for
successful treatment.
Journal of Innovative Dentistry, Vol 1, Issue1, Jan-April 2011
ARTICLE
In a prospective study[7] the efficacy of the
treatment of mandibular fractures using a
2.0 mm nonlocking miniplate and 2 weeks
of IMF was with a complication rate of
4.52% whereas complication rate in our
study in nonlocking group was 18.2% with
postoperative IMF period of 7 days. The
higher complication rate in our study cannot
be directly attributed to the lesser period of
IMF. Other factors related to patient,
operator, and surgical technique may also
influence the complication rate.
In another study on 2.0 mm locking
miniplate screw system in the treatment of
mandibular fractures with 1 week period of
IMF, it was found that a single 2.0-mm
locking mini plate placed along Champy’s
line of ideal osteosynthesis plus one week of
IMF is a reliable and effective treatment
modality for mandibular fractures [8]. Several
researchers advocated that postoperative
IMF should be done for a period of 2 weeks
to 4 weeks[7, 9].
In our study, it was observed that only 2
patients in Group A required postoperative
IMF; that too for a period of 5 days and
complication rate was 4.7%. The result of
our study also supports the concept of higher
stability of the locking miniplate plate
system as compared to nonlocking miniplate
system. We strongly recommend no
postoperative IMF or if required, IMF for a
period of 5 days, which is supported by
many other studies [10, 11].
As observed in our study the infection rate
was higher in nonlocking group (13.6%) as
compared to locking group (4.7%). In
patients with persistent infection, it was
found that loosening of screws were present
on surgical exploration in nonlocking group
as compared to locking group. Total
infection rate observed in our study was
9.3% and similar kind of observations were
being recorded in other studies with the
almost similar rate of infection[9, 11, 12].
Conclusion:
______________________________________________________ ORIGINAL
From this study we concluded that locking
plates are superior to conventional
miniplates taking into account its various
advantages. The use of locking miniplates in
mandibular fracture is efficacious enough to
bear masticatory loads during the
osteosynthesis of fracture. It has greater
stability, less precision required in plate
adaptation because of the “internal/external
fixator”, less alteration in periosteal blood
supply and reducing the need and duration
of IMF.
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Journal of Innovative Dentistry, Vol 1, Issue1, Jan-April 2011
ARTICLE
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