Dr. José Frota Institute.
Batista Memorial Hospital, Fortaleza.
J Craniofac Surg. 2020 Nov/Dec;31(8):e753-e755. doi: 10.1097/SCS.0000000000006630.
Poor proprioception, weakness, and impaired reflexes increase the incidence of facial fracture in the elderly. Mandibular fractures in these people range from 10.1% to 56%. Fragment reduction and fracture consolidation are difficult due to bone atrophy, decreased capacity for bone regeneration, and lack of anatomical landmarks to guide the alignment of the fragments. This study reports 2 patients with different conducts regarding the treatment of bilateral fractures in atrophic mandible. The first patient refers to the removal of plates of the 2.4 mm system with low profile, which failed during the mandibular function, being replaced by the 2.4 mm system with high profile. The 2nd clinical reports the use of the 2.0 mm system only to simplify the mandibular fracture, and then reconstructing that with a 2.4-mm system with high profile, using the load bearing principles. Regarding mandibular fractures, an important goal is to neutralize the muscle action aiming the bone stability. There are several methods to treat that the indication should consider the load bearing and load sharing concepts. The incorrect fixation choice in these patients can result in complications as bad union, material failure, infection, and consequent treatment failure.
本体感觉差、无力和反射受损会增加老年人面部骨折的发生率。这些人的下颌骨骨折发生率为 10.1%至 56%。由于骨萎缩、骨再生能力下降以及缺乏解剖学标志来指导碎片的对齐，因此骨折复位和固定较为困难。本研究报告了 2 例不同治疗方法的萎缩性下颌骨双侧骨折患者。第 1 例患者提到在进行下颌功能时，低轮廓的 2.4mm 系统的钢板失败，被高轮廓的 2.4mm 系统所取代。第 2 例临床报告仅使用 2.0mm 系统来简化下颌骨骨折，然后使用高轮廓的 2.4mm 系统进行重建，使用承重原则。对于下颌骨骨折，一个重要的目标是通过中和肌肉作用来稳定骨骼。有几种治疗方法，适应证应考虑承重和分担负荷的概念。在这些患者中，如果选择不当的固定方法，可能会导致不良愈合、材料失效、感染和随后的治疗失败等并发症。
