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PubMed2006

Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate.

The study was a retrospective evaluation and comparison. Seventy-five elderly patients (>50 years) with AO type-B2 ankle fractures were treated by open reduction and internal fixation. All patients were followed up retrospectively for at least 12 months. The 75 patients were divided into two groups, based on the method of treatment. The Knowles pin (KP) group included 45 patients with an average age of 62.7 years. The tubular plate (TP) group included 30 patients with an average age of 60.0 years. The clinical results were compared between the two groups. Both of the groups were similar in respect to the injury mechanisms, fracture pattern, open fracture grade, compounding medical conditions, and ankle score (all P values <0.28). However, the KP group had significantly smaller wound incisions, shorter surgery time, shorter hospital stay, less meperidine use, less symptomatic hardware, and lower complication rates than the TP group (all P values <0.03). In conclusion, lateral fixation of AO type-B2 ankle fractures in the elderly by the Knowles pin is recommended due to its simplicity, efficacy and low complication rate.

Bone Nails↗
PubMed2003

Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique.

BACKGROUND: The femoral fixation of hamstring tendon grafts by a cross-pin is an established method with excellent biomechanical properties. Until now, this surgical procedure was associated with a transtibial placement of the femoral tunnel and a graft-tunnel diameter mismatch due to the different volumes of the tendon loop and the tendon strands. METHODS: By use of an electrical knee positioning device, the transfixation technique can be performed safely through the anteromedial arthroscopic portal (transarticular technique), reaching the optimal lateral '10:30' position in the intercondylar notch. By use of a specific harvesting and implantation device, a cancellous bone plug is harvested and inserted into the femoral tunnel, thus stabilizing the tendon bundle and eliminating dead space in the tunnel. CONCLUSION: The femoral cross-pin guarantees a secure anchorage of the graft, drilling through the anteromedial portal eases optimum tunnel placement, and the insertion of a solid cancellous bone plug eliminates the femoral graft-tunnel diameter discrepancy and improves the press-fit contact between graft and tunnel wall. The long-term benefit of this technical modification remains to be proven.

Absorbable Implants↗
PubMed2003

Surgical correction of deformities of the distal radius due to fractures in pediatric patients.

INTRODUCTION: The indication and treatment of malunited fractures of the distal radius in the growing skeleton differ from those for adults. The literature results are scarce. In this study we examined the results of surgical correction following fractures of the distal radius in infants. MATERIALS AND METHODS: Seven infant patients with malaligned fractures of the distal radius that demonstrated significant functional deficit and poor prognosis for spontaneous recovery were treated with surgical correction. Two of them were treated because of growth disturbance from post-traumatic closure of the distal radial physis. RESULTS: All seven osteotomies healed with acceptable radiologic alignment. After an average follow-up period of 3 years and 1 month (range 10 months to 8 years and 4 months), patients had an average range of wrist motion (ROM) of 131 deg in extension and flexion (93% of the contralateral side, 130% of presurgical situation); 65 deg in ulnar and radial deviation (94% of the contralateral side, 122% of presurgical situation); and 177 deg in pronation and supination of the forearm (97% of the contralateral side, 115% of presurgical situation). The average grip strength of 71.4 kPa was nearly equal to the other side with 72.8 kPa. The average postoperative angulation of the distal radius was 12 (range 10-17) deg, the radial inclination 20 (range 12-30) deg, and the ulnar variance was -0.6 (range -3 to +2) mm. According to the Fernandez point score system as well as the scale of Fernandez, there were five excellent results and two good results. The patients described low disability on the DASH scores, with a median of 4 (range 0-41) points. CONCLUSIONS: Surgical correction for malunited fractures of the distal radius provides good and excellent radiological and functional results in the growing skeleton. It should be considered immediately if there is poor remodeling capacity and disabling loss of function.

Adolescent↗
PubMed2004

Hybrid external fixation of distal tibial fractures: new strategy to place pins and wires without penetrating the anterior compartment.

INTRODUCTION: Impalement of the anterior compartment musculature remains a problem in the hybrid external fixation of distal tibial fractures. The purposes of this study were to develop a tensioned wire configuration which does not violate the anterior compartment and to analyze the biomechanical implications of new wire configuration. MATERIALS AND METHODS: Thirty-seven adult volunteers without known pathology around either tibia were recruited. Axial computed tomography of the distal tibia was performed at 5-mm slices from the plafond to the upper margin of the syndesmosis. The wire convergence angle was measured at the 1-, 2-, and 2.5-cm levels using the following landmarks: tibialis anterior tendon (TA), tibialis posterior tendon (TP), peroneus brevis tendon (PB), anterolateral border of the lateral malleolus (LM). Two straight lines were drawn by connecting TA and PB and connecting TP and LM. The wire convergence angle was defined as an acute angle between these two lines. Then the orientation of the bisector axis of the wires was measured. As a second part of this study, a validated three-dimensional hybrid external fixator model was developed using finite elements modeling to analyze the stiffness of the frames constructed according to the measured wire convergence angle and orientation. Five simulated configurations were tested. The stiffness of each frame was analyzed under four load conditions: torsion, axial compression, side bending, and anteroposterior bending. RESULTS: The mean convergence angle was 30 degrees irrespective of the level. The bisector axis was oriented towards the anterolateral direction about 20 degrees from the coronal plane. The stiffness of the frame constructed with a wire convergence angle of 30 degrees and an anterolateral wire orientation of 20 degrees was 20-30% less than that of the frame constructed with 60 degrees wires oriented in a coronal plane. The addition of an anteromedial half-pin increased the stiffness significantly. CONCLUSIONS: Two tensioned wires may be placed without violating the anterior compartment by using the above four clinically identifiable landmarks. Addition of a half-pin on the anteromedial surface of the distal articular fragment makes the frame markedly stiffer than is possible using the standard wire configuration.

Adult↗
PubMed2005

Stabilisation of periprosthetic fractures with angular stable internal fixation: a report of 13 cases.

INTRODUCTION: Periprosthetic fractures of the femur present a challenging surgical problem. The aim of this study was to retrospectively evaluate the outcome of periprosthetic fractures stabilised with an angular stable, less invasive stabilisation system (LISS). PATIENTS AND METHODS: Thirteen patients (ten total hip-, two total knee-, one total hip- and knee-arthroplasty) with periprosthetic fractures were treated with the LISS internal fixator (in ten cases minimal invasive). Six patients had previous operations due to periprosthetic fractures. The average follow-up period was 20 months, follow-up rate 85%. RESULTS: All fractures showed radiographic fracture healing without implant loosening. Except one patient, all patients had returned to their pre-operative activity level. No early post-operative complications were seen. There was one implant failure after 4 months and two cases of malunion. CONCLUSION: The cases showed the internal fixator to be effective for the stabilisation of periprosthetic fractures, even in cases of poor bone quality with good functional outcomes. The internal fixator, with the option of minimal invasive application, is the preferred method of osteosynthesis in periprosthetic fractures.

Accidental Falls↗
PubMed2006

Management of a nonunion of the distal femur in osteoporotic bone with the internal fixation system LISS (less invasive stabilization system).

We present a case illustrating the successful use of the internal fixation LISS in an osteoporotic nonunion of the distal femur, where classic osteosynthesis has failed. The LISS plate with its angular stability offered the possibility to achieve excellent purchase in the severely porotic and partially destroyed bone. In combination with the use of an autologeous bone graft laterally and a strut cortical autograft medially, a mechanical support and an osteoinductive stimulus was provided and the extremity could be saved by this procedure.

Aged, 80 and over↗
PubMed2006

Complications at screw removal in slipped capital femoral epiphysis treated by cannulated titanium screws.

INTRODUCTION: Various modes of fixation are proposed for the treatment of slips of the capital femoral epiphysis (SCFE). We describe our experience with the use and removal of a new, cannulated titanium screw (Asnis III, Stryker, Howmedica). PATIENTS AND METHODS: Single cannulated titanium screws had been inserted in 101 hips of 65 patients in the 3-year period from 2001 to 2003. These pins were used for in situ fixation of minor chronic slips in 41 patients and for prophylactic fixation on the contralateral side in patients with open physis in 60 patients. RESULTS: The insertion of these screws was achieved without any real problem. The mean surgical time was 25 min (13-46 min). Problems came up when we started to remove the pins. Hardware retrieval was attempted in 27 patients with 43 pins. The mean surgical time for removal was double the average time of insertion with 51 min (26-107 min). The hexagonal Allen sockets proved to be too weak to overcome the necessary torque for loosening the pin from bone and applying the reverse-cutting-force, necessary to extract the pin. Eleven patients needed extensive chiselling. Two adolescents sustained a subtrochanteric fracture 5 and 7 weeks after hardware removal. Seven pins could not be totally removed. CONCLUSION: Due to the considerable disadvantages encountered in our series we conclude that Asnis III cannulated screws should be suspended from further use in SCFE.

Adolescent↗
PubMed1998

Redisplacement after ankle osteosynthesis with absorbable implants.

A total of 1202 fractures of the ankle were treated with absorbable implants made of polyglycolide/polylactide copolymer or self-reinforced polyglycolide and/or self-reinforced polylactide between November 5, 1984, and January 12, 1994. A redisplacement after fixation was diagnosed in 30 patients (2.5%). The redisplacement occurred in 8 of 934 (0.9%) simple ankle fractures and in 22 of 268 (8.2%) severer ankle fractures. A breakage or loosening of the absorbable implant was verified at reoperation in 8 cases and was suspected in another 9. A technical failure was the main reason in 13 cases. A reoperation was performed for 25 patients. The absorbable implants seem to provide a secure fixation in the majority of ankle fractures, but the use of these implants showed unsatisfactory results in unstable and comminuted fractures.

Absorption↗
PubMed2001

Complications of K-wire fixation of fractures and dislocations in the hand and wrist.

Kirschner wire (K-wire) fixation of fractures and dislocations of the hand and wrist is a common procedure. Of the 590 K-wire fixations performed on 236 patients, 36 (15.2%) experienced complications which included osteomyelitis, tendon rupture, nerve lesion, pin tract infection, pin loosening or migration. There were no deep soft-tissue pin infections or pyarthrosis. Technical failure, mainly when the procedure was performed by residents, and poor patient compliance were the major causes of complications. K-wire fixation is a simple but demanding procedure that cannot be left to an inexperienced resident. Elimination of technical failure, supervision in the operating room, close monitoring, prompt treatment upon discovery of a complication, and improvement of patient compliance can reduce the rate of complications.

Bone Nails↗
PubMed2006

Thoracolumbar fractures surgically treated by "in situ contouring".

This is a retrospective study on a series of 70 patients with thoracolumbar fractures (TL), surgically treated by the in situ bending technique (ISB). Its purpose is to show the performances and limits of the ISB technique for the early correction of post-traumatic spine deformities as well as to estimate the overall outcome in this series and to discuss the indications for anterior grafting. Although the management of limbs fractures is a cleared issue today, spine fractures management is still a matter of debate. Surgical treatment progresses fast, while indications, the fixation techniques, fracture reduction options, and associated grafting are still blurry. Seventy patients with TL fractures, mean age 40.3 years (20-80) were treated by posterior fusion with a standard construct and deformity reduction by means of the ISB technique. Mean follow-up was 30.7 months (12-78). Pre- and post-operative deformity was evaluated and the relative deformity as defined by Farcy's sagittal index (SIF) was analyzed. Thirty-eight patients underwent anterior interbody grafting. The pre-operative SIF decreased from 16.98 to 1.62 degrees (15.36 degrees decrease). Eighty percent of patients were normo- or hyper-corrected. The loss of correction during the follow-up occurred within the disc (SIF: -2.24 degrees , vertebral kyphosis 0.94 degrees , p<0.001), and was lower in patients who underwent secondary anterior grafting (-5.21 degrees vs.-1.18 degrees , p=0.002). Clinical outcome is good (Oswestry=29.75) and seems to be better in cases of double approach (20.71 vs. 37.,4, p=0.001). Sepsis occurred in ten cases, and two patients experienced construct dismounting. One patient had a retroperitoneal hematoma that required embolization. Seventy-one percent of operated patients went back to their previous work after surgery. Spine fractures deserve an efficient treatment. The ISB technique improves post traumatic kyphosis. This results is maintained at long term if the posterior fusion is associated with anterior grafting in cases where the correction within the disc exceeds 50% of the total correction.

Adult↗
PubMed2006

Atlantoaxial fixation using the polyaxial screw-rod system.

The aim of this study is to evaluate the first results of the atlantoaxial fixation using polyaxial screw-rod system. Twenty-eight patients followed-up 12-29 months (average 17.1 months) were included in this study. The average age was 59.5 years (range 23-89 years). The atlantoaxial fusion was employed in 20 patients for an acute injury to the upper cervical spine, in 1 patient with rheumatoid arthritis for atlantoaxial vertical instability, in 1 patient for C1-C2 osteoarthritis, in 2 patients for malunion of the fractured dens. Temporary fixation was applied in two patients for type III displaced fractures of the dens and in two patients for the atlantoaxial rotatory dislocation. Retrospectively, we evaluated operative time, intraoperative bleeding and the interval of X-ray exposure. The resulting condition was subjectively evaluated by patients. We evaluated also the placement, direction and length of the screws. Fusion or stability in the temporary fixation was evaluated on radiographs taken at 3, 6, 12 weeks and 6 and 12 months after the surgery. As concerns complications, intraoperatively we monitored injury of the nerve structures and the vertebral artery. Monitoring of postoperative complications was focused on delayed healing of the wound, breaking or loosening of screws and development of malunion. Operative time ranged from 35 to 155 min, (average 83 min). Intraoperative blood loss ranged from 50 to 1,500 ml (average 540 ml). The image intensifier was used for a period of 24 s to 2 min 36 s (average 1 min 6 s). Within the postoperative evaluation, four patients complained of paresthesia in the region innervated by the greater occipital nerve. A total of 56 screws were inserted into C1, their length ranged from 26 to 34 mm (average, 30.8 mm). All screws were positioned correctly in the C1 lateral mass. Another 56 screws were inserted into C2. Their length ranged from 28 to 36 mm (average 31.4 mm). Three screws were malpositioned: one screw perforated the spinal canal and two screws protruded into the vertebral artery canal. C1-C2 stability was achieved in all patients 12 weeks after the surgery. No clinically manifested injury of the vertebral artery or nerve structures was observed in any of these cases. As for postoperative complications, we recorded wound dehiscence in one patient. The Harms C1-C2 fixation is a very effective method of stabilizing the atlantoaxial complex. The possibility of a temporary fixation without damage to the atlantoaxial joints and of reduction after the screws and rods had been inserted is quite unique.

Adult↗
PubMed1998

Treatment of fractures of the thoracolumbar spine by combined anteroposterior fixation using the Harms method.

Forty-three patients with fractures of the thoracolumbar spine submitted to surgical treatment using the Harms method (dorsoventral operations) were studied prospectively with a follow-up of at least 12 months and evaluated on the basis of clinical and radiologic parameters and in relation to their professional activities. Thirty-five patients (81.3%) were males and eight (18.7%) females, ranging in age from 17 to 67 years (mean 34.08+/-11.51 years). Seven patients (16.2%) presented fractures of more than one vertebra, and associated lesions were present in 15 patients (34.8%). Monosegmental fixation was performed in 7 patients (16.3%), bisegmental fixation in 29 (67.4%), and trisegmental fixation in 7 (16.3%). No patient was submitted to any type of external immobilization during the postoperative period and all patients were allowed to sit up in bed and to walk as soon as their clinical conditions permitted. Thirty-nine patients were followed up for a period ranging from 12 to 36 months (mean 16.58+/-6.83 months). Four patients died during the postoperative period (three of pulmonary embolism and one of septicemia). Forty-two patients sat up in bed between the 2nd and 6th postoperative day, and those who did not present a disabling lesion (Frankel D or E) or other associated lesions walked between the 4th and 10th postoperative day (mean 6.14+/-6.06 days). The neurological signs and symptoms improved in 16 patients (37.3%), were unchanged in 26 (60.4%), and worsened in 1 (2.3%). Twenty-three patients (87.5%) who had no neurological damage (Frankel E) returned to their professional activities after respective periods of disability of 1 month (three patients), 2 months (four patients), 3 months (one patient), 4 months (seven patients), 5-7 months (five patients), 8-12 months (one patient), and more than 12 months (three patients). The ability to work of the 24 patients without neurological damage was 100% in 21, 50% in 2, and zero in 1. The ability to walk of this group of patients was 1-5 km for 4 and more than 5 km for the remaining 20 patients. The complications observed were death (four patients; three cases of pulmonary embolism and one case of septicemia), infection (two patients), Stevens-Johnson syndrome (one patient), and meningitis (one patient). The mean kyphosis of the fractured segment was 22.17 degrees +/- 10.97 degrees preoperatively, 8.55 degrees +/- 6.9 degrees postoperatively, and 10.30 degrees +/- 8.84 degrees on the occasion of late evaluation. No loss of correction occurred in 28 patients (71.8%), a 5 degrees loss was observed in 3 patients (7.6%), a 6 degrees loss in 3 (7.6%), a 7 degrees loss in 3 (7.6%), and a loss of more than 10 degrees in 2 (5.2%).

Adult↗
PubMed2001

Comparison of a new bisphenol-a-glycidyl dimethacrylate-based cortical bone void filler with polymethyl methacrylate.

A newly formulated and reinforced bisphenol-a-glycidyl dimethacrylate (bis-GMA) resin (Cortoss/Orthovita, Malvern, Pa.) was compared with Simplex P polymethyl methacrylate (Stryker Howmedica Osteonics, East Rutherford, N.J.) in rabbits for up to 52 weeks and in sheep for up to 78 weeks. As seen in scanning electron microscopy and histology examinations, both implant materials were surrounded by bone at late time periods, with fibrous layers of connective tissue seen in half the Simplex P specimens. No clinically significant safety differences between implant materials were apparent. Interfacial bond strengths between the implant and bone generally increased with time, but were 4.5-fold greater with Cortoss than Simplex P at 24 weeks, and 100-fold greater at 52 weeks. Forces required to displace 316SS rods held in place with Cortoss were consistently greater than forces to displace rods held in place with Simplex P. No statistically significant differences in displacement forces were found between rods held in place with Cortoss polymerized in situ and rods held with prepolymerized Cortoss. Interfacial bond strengths were greater for Simplex P that was polymerized in situ than for prepolymerized polymethyl methacrylate specimens. Cortoss synthetic cortical bone void filler is a good candidate material to fix implants in bone. It has characteristics consistent with long-term safety and has a better ability to bond to bone than Simplex P.

Animals↗
PubMed2002

Palliative occipito-cervical stabilization in patients with malignant tumors of the occipito-cervical junction and the upper cervical spine.

BACKGROUND: Occipital-cervical stability may be impaired in patients with primary malignant or metastatic tumors of the cranio-cervical junction and the upper cervical spine. The purpose of this study was to evaluate occipital-cervical fixation with pre-bent titanium-loops and sublaminar wiring in order to achieve a rigid and safe stabilisation of the occipito-cervical region in this group of patients. METHOD: 20 patients with severe impairment of occipito-cervical stability due to primary malignant or metastatic cervical bone involvement were included in this study. For palliation of symptoms, resulting from destructive instability, a stabilization procedure using Ransford Loops with sublaminar cable fixation was used in these patients as a palliative therapeutic concept. FINDINGS: Pain which was the major symptom in all patients treated, showed good and immediate response to the stabilization procedures. All 20 patients were either pain free or had good improvement with less intake of analgesic drugs. Signs of spinal cord compression like spasticity and quadraparesis were less likely to improve after surgery. However in 3 of 5 patients neurological function improved after surgery whereas in 2 patients no improvement was achieved. INTERPRETATION: In all patients with impaired occipito-cervical stability due to primary malignant or metastatic tumors of the occipito-cervical junction and the upper cervical spine, immediate stabilization resulting in an improvement of pain was achieved. Occipito-cervical stabilization using contoured Ransford loops is a promising palliative therapeutic concept in this group of patients.

Adult↗
PubMed1999

Intra-focal fixation for treating distal radius fracture: results of 104 cases.

Intra-focal fixation for a displaced distal radius fracture is a surgical option that achieves early functional recovery. We report a retrospective evaluation of the results with various types of distal radius fracture, using various fixation materials in 104 patients (69 women and 35 men; average age, 51.4 years; range, 4-91 years). Fracture types classified according to Frykman were: 14 type I, 15 type II, 6 type III, 16 type IV, 10 type V, 16 type VI, 9 type VII, and 18 type VIII. Fixation materials used were: conventional Kirschner wire in 6 patients, threaded Kirschner wire in 38, arum pins in 38, and conehead wedging screws in 22. The results for patients with Frykman types V-VIII fractures were not as good as those for patients with types I-IV. The arum pin and conehead wedging screw were each superior to either Kirschner wire or threaded Kirschner wire in reducing the fracture and in maintaining fixation. Our evaluation suggested that intra-focal fixation was also suitable for treatment of an intra-articular fracture. In elderly patients, we recommend the arum pin and conehead wedging screw as fixation materials, and suggest short-term postoperative immobilization.

Adolescent↗
PubMed2003

Distraction osteogenesis for treatment of bone loss in the lower extremity.

Distraction osteogenesis has been widely utilized to treat leg length discrepancy, deformity, nonunion, osteomyelitis, and bone loss. It has been found that most difficult conditions can be resolved with this method. This paper introduces the usefulness of distraction osteogenesis for the treatment of nonunion and bone loss after tumor excision. The procedure was found to be extremely effective for the treatment of nonunion accompanied by bone loss and infected nonunion. In particular, the Ilizarov method offers a simultaneous solution for several problems related to nonunion, such as instability, infection, deformity, bone loss, joint contracture, limb length discrepancy, and skin defects. In addition, distraction osteogenesis is safe, useful, and efficient for the treatment of bone loss even after tumor excision. Joint preservation and reconstruction by means of distraction osteogenesis is the most conservative limb-saving surgery available at present. Furthermore, distraction osteogenesis can provide natural limb regeneration.

Bone Nails↗
PubMed2003

[Memory effect of resorbable polymers].

BACKGROUND: The present study analyzed the memory effect of resorbable polymers. Depending on temperature, this effect describes the ability of different materials to "remember" their original form after mechanical deformation. Resorbable polymers serve as materials to stabilize and fix bone fractures. Compared to metal transplants, resorbable polymers are able to undergo thermoplastic deformation. The precise adaptation of the transplant to the surrounding bone guarantees an exact anatomical reconstruction. However, during normal applications, it was observed that these biodegradable plastic materials tend to revert to their original form at body temperature. This "memory effect" could result in negative consequences for the medical treatment. METHODS: By the process of compression molding, geometrically formed specimens (lattice, rod, plate) consisting of different polyglycolides and polylactides were prepared. After warming up the specimens to 50 degrees C (water bath) they were deformed into definite angles. Following this procedure, the specimens were put in a water bath at 37 degrees C to mimic the adaptation of the transplant at body temperature. The retroflexion of the material (memory effect) was measured using an XY-measuring desk. RESULTS: The present study clearly reveals that highly deformed specimens react with stronger retroflexions. In addition, the results indicate that the memory effect depends on geometrical design as well as on chemical composition. All tested polymers showed a strong initial memory effect that decreased with time.

Absorbable Implants↗
PubMed2004

[Stability of osteosyntheses for condylar head fractures in the clinic and biomechanical simulation].

BACKGROUND: Fractures of the condylar head are traditionally managed by closed techniques, despite a considerable rate of dysfunctional problems. PDS pin osteosynthesis (presented by Rasse 1992) via a preauricular approach failed to become established as a standard procedure due to a lack of stability. Alternatively, mini- or microplating, as performed in our patients (101 condylar head fractures between 1993 and 2000), showed high-grade limitations of translatory movements in about 30% due to scarification after loosening of osteosynthesis materials. The aim of this study was to establish an efficient procedure for achieving a functionally stable and atraumatic osteosynthesis. METHODS: For the definition of a suitable procedure, models of the mandible (standardized fractures, types A, B, and C) were osteosynthesized (six samples for each type of fracture and type of screw), each with three PDS pins, 2.0 mm resorbable, 2.0 cortical, 1.7 and 1.2 mm small fragment screws, and exposed to increasing loads in centric (0-20-35 mm opening) and eccentric (35 mm opening) condylar positions. A computerized biomechanical test stand allowed a dynamic simulation of chewing forces (16 hydraulic drives). The resulting fracture gaps were measured without contact by a motion capture system. RESULTS: Within physiological limits, only 1.7 small fragment and 2.0 mm cortical screws were able to bear occlusal loadings up to 200 N (1.2 mm small fragment screws up to 150 N, resorbable 2.0 mm screws up to 100 N, and PDS-pins up to 50 N). In a pullout experiment (condylar spongious bone of young pigs, aged 4-6 months), 1.7 mm small fragment screws showed superior retention. A consecutively developed small fragment screw-system has been applied clinically in 74 condylar head fractures (58 patients). After removal of osteosynthesis material, 41 of 49 TM joints have so far shown complete restitution. CONCLUSIONS: The newly developed osteosynthesis system using a retroauricular approach based on 1.7 mm small fragment screws makes maxillomandibular immobilization unnecessary. The extra-articular position of the screw heads prevents scar-induced articular limitations. Preexisting degenerative alterations of the TMJ soft tissues, however, will affect functional results adversely.

Absorbable Implants↗