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Мета. Оцінка стабільності внутрішньої фіксації при виконанні різних видів надкісточкових корекційних остеотомій дистального відділу великогомілкової кістки шляхом дослідження жорсткісних параметрів біомеханічних моделей «фіксатор — кістка» при імітаційному комп’ютерному моделюванні методом скінченних елементів. Матеріали та методи. Дослідження включало створення солідних імітаційних комп’ютерних моделей біомеханічних систем «фіксатор — кістка» на базі програмного комплексу ANSYS з використанням контактних і 10-вузлових пірамідальних 3D SOLID187 СЕ. 3D-модель великогомілкової кістки створена на підставі комп’ютерного томографічного дослідження неушкодженої гомілки у здорової людини. У кожній моделі відтворено корекційну остеотомію в метаепіфізарній зоні дистального відділу великогомілкової кістки з подальшою фіксацією різними видами сучасних блокованих пластин з гвинтами. Проведено дослідження напружено-деформованого стану, визначені максимальні величини зусиль на стиск, згин та максимальні крутильні моменти за умови неперевищення переміщення 1,0 мм між кістковими фрагментами. Результати. Найбільш жорсткою та стабільною є біомеханічна система з передньолатеральною блокованою L-подібною пластиною, де допустимі зусилля на стиск і згин становлять 308 і 73 Н відповідно. При цьому ця система характеризується найбільшою величиною еквівалентних за Мізесом напружень у концентраторах гвинтів та пластини. Найменшу жорсткість на стиск (Pmax стиск = 151 Н), згин (Pmax згин = 19 Н) і кручення (Mmax = 2,46 Н/м) мала біомеханічна система, де застосовано медіальну блоковану пластину. Висновки. При плануванні медіальної корекційної надкісточкової остеотомії дистального відділу великогомілкової кістки з відкритим клином найбільшу стабільність та жорсткість фіксації забезпечує медіальна блокована пластина «puddi-plate», при плануванні медіальної остеотомії із закритим клином найбільшу стабільність при фіксації забезпечує медіальна блокована пластина з міні-гвинтами, а для латеральної корекційної остеотомії із закритим клином, передньої остеотомії та фокусної купольної корекційної остеотомії в даній анатомічній ділянці найкраще використовувати передньолатеральну L-подібну блоковану пластину.

Post-traumatic osteomyelitis (PTO) is a worldwide problem in the field of orthopaedic trauma. So far, there is no ideal treatment or consensus-based gold standard for its management. This paper reviews the representative literature focusing on PTO, mainly from the following four aspects: (1) the pathophysiological mechanism of PTO and the interaction mechanism between bacteria and the body, including fracture stress, different components of internal fixation devices, immune response, occurrence and development mechanisms of inflammation in PTO, as well as the occurrence and development mechanisms of PTO in skeletal system; (2) clinical classification, mainly the etiological classification, histological classification, anatomical classification and the newly proposed new classifications (a brief analysis of their scope and limitations); (3) imaging diagnosis, including non-invasive examination and invasive examination (this paper discusses their advantages and disadvantages respectively, and briefly compares the sensitivity and effectiveness of the current examinations); and (4) treatments, including antibiotic administration, surgical strategy and other treatment programs. Based on the above-mentioned four aspects, we try to put forward some noteworthy sections, in order to make the existing opinions more specific.

Various techniques of reconstruction of deformed Charcot hindfoot using different internal fixation devices have been described in the literature. We present our surgical technique using specific principles that has resulted in improved outcomes to allow correction of deformity, obtain stability and allow progression to weightbearing in orthotic shoes. We describe our preoperative evaluation, planning and surgical timing. We also hope to share some technical pearls and details on the finer points to achieve a satisfactory correction and reduce the learning curve.

The infection of internal fixation devices of rib fractures is rare, but it is usually severe when it occurs. Existing literature indicates that removal of infected hardware is essential for the clearance of refractory infection. We report a rare case of a patient who accepted operation for rib fractures; however, his hardware infection was not controlled after the removal of internal fixation devices, until the necrotic ribs were removed by the third operation.

In earlier times, apart from infectious diseases, the treatment of complex wounds and fractures was a great challenge to physicians and surgeons. The craniofacial skeleton owing to its complex anatomy and proximity to vital structures is more difficult to treat when compared to other parts of the human skeletal system. Initially, surgeons used nonrigid materials to stabilize the fracture segments until the union was complete. Discovery of biocompatible metals and construction of various fixation devices took fracture management to its next level. Biocompatible metals owing to their inert nature can be fixed inside the body; thus, the term “internal fixation” came to existence. Following this, researchers continuously developed various internal fixation devices, which are being modified and developed according to the requirements, till date. Apart from the fixation devices, several instruments have also been developed, which help in fixation of these devices. Due to the unique nature of the craniomaxillofacial region, it requires armamentarium that is specially designed to be used in this region. This chapter briefly describes the various fixation devices and other armamentarium that are used in craniomaxillofacial trauma management.

The simultaneous use of external and internal fixation devices is a surgical procedure that combines two different techniques of bone osteosynthesis, with different timing and methods, in order to benefit from the advantages, to eliminate the mutual drawbacks and to reduce treatment time.

Varus derotation femoral osteotomy (VDFO) is a commonly used surgical procedure in association with pelvic osteotomy for dislocated hip in developmental hip dysplasia. Several types of internal fixation devices were described in the literature, but none of them showed a superiority or a lower rate of complication over the others. Different types of external fixator were also described for proximal osteotomy fixation with good results. We describe the surgical technique of the VDFO using a modular external fixator with an illustrative case.

Valgus osteotomy using biomechanical principles with internal fixation devices like the dynamic hip screw (DHS) by which fracture fixation of the femoral neck can be done satisfactorily. It is mentioned here on account of its historical importance of the evolution of hip-preserving surgery.

Internal fixation devices, and specifically bone plate and screw assemblies, are among the most common implantable medical devices that a failure analyst may encounter. These devices most often fracture by fatigue crack initiation and growth. This article discusses potential root causes of internal fixation device fractures and describes the process of metallurgical and nondestructive examination of these assemblies. Two fractured internal fixation device case studies are reviewed.

Single-pin external Kirschner wire (K-wire) fixation has traditionally been a mainstay in proximal interphalangeal joint fusion for central hammertoe repair. Concerns over cosmesis, inconvenience, pin tract infection, hardware failure, nonunion, and early hardware removal have led to the development of implantable internal fixation devices. Although numerous implantable devices are now available and represent viable options for hammertoe repair, they are costly and often pose a challenge in the event removal becomes necessary. An alternative fixation option not typically used is a 2-pin K-wire fixation technique. The perceived advantage of obtaining 2 points of fixation compared with 1 across the fusion site is improved stability against the rotational and bending forces, thus decreasing the potential for pin-related complications. A retrospective assessment of 91 consecutive hammertoe repairs consisting of proximal interphalangeal joint fusion with 2-pin fixation in 60 patients was performed. The K-wires were removed at 6 weeks postoperatively, and the overall postoperative follow-up duration was 28.56 (range 1.40 to 86.83) months. Of the 91 digits, 89 (98%) did not encounter a complication postoperatively and 2 (2.20%) had sustained loosened or broken hardware. No postoperative infection was encountered. The low incidence of complications observed supports the 2-pin K-wire fixation technique as a low-cost and viable construct for proximal interphalangeal joint fusion hammertoe repair.

Long bone fractures are primarily treated with internal fixation devices, and intramedullary (IM) nails are the most commonly used. Reamed and unreamed surgical procedures are commonly used to attach IM nails to fractured bones. It is believed that the use of flexible composites contributes to successful fracture healing because of the desirable initial interfragmentary movement (IFM) provided by the material. This finite element study was conducted to understand the influence of initial IFM on the healing process by using various IM nail materials (stainless steel, carbon/epoxy composites (WSN3k [0]2nT, WSN3k [±30]nT) and glass/polyprophylene (Twintex [0]2nT) composite). Reamed and unreamed IM nails were used to investigate the effects of mesenchymal cell activities, deviatoric strain, and body fluid flow in calluses on bone healing. The results showed that unreamed IM nails promoted healing because of a 40% increase in initial cells supplied to the central callus, compared to reamed nails. The most suitable initial interfragmentary strains (IFS) (18.3% and 6.85%, reamed and unreamed) were provided by the flexible Twintex [0]2nT IM nail and this induced 38% and 40.33% healing performances by the reamed and unreamed IM nails, respectively. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (No. 2017R1A2B2005261). Scopus

Objective: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. Methods: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. Results: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). Conclusions: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS.

The purpose of this paper is to report the cases of 7 subjects who lacked full range of motion (ROM) in the elbow, and my treatment regimen of PSWD and joint mobilizations. 7 subjects presented with decreased elbow (ROM) due to extensive fractures and or dislocations from traumatic injuries. All subjects were post-surgical, 2 with internal fixation devices. Initial active extension for each patient was 17°, 23°, 28°, 25°, 45°, 30°, 26° respectively (range of 17-45 degrees). Treatment regimen consisted of PSWD to the anterior elbow for 20 min at 48 watts. Immediately after PSWD, mobilizations were administered to the elbow. Extension improved 19°, 21°, 25°, 23°, 20°, 30°, and 26°, respectively, after 6 or less treatments (range of 19-30 degrees). All but 1 patient returned to normal activities with functional ROM in all planes. Follow-up 4 weeks later indicated that all of the subjects maintained 85-100% of their extension. No negative effects were reported during the short-term follow-up. When precautions are taken, I propose PSWD (48 W) may be an appropriate adjunct to joint mobilizations to increase ROM in peripheral joints despite implanted metal.

The fabrication of personalized implants, tailored on patient needs, is a key issue for the future of several surgical fields. The presence of a prototyping service inside the hospital would be an added value for improving clinical activity. In this context, micro-Electro Discharge Machining is exploited to customize fixation devices in orthopedic surgery. An overview of the main devices is carried out in order to identify the main characteristics and to define the common fixation system specifications. The experimentation includes a technological evaluation of the proper micro-EDM technology, chosen according to the final design of the components. Two materials are investigated for the device fabrication: titanium and Si3N4-TiN ceramic composite. An optimization of the main technological parameters is performed in order to maximize the material removal rate ensuring the accuracy of the micro-features required. Finally, a test case is selected in order to evaluate the entire fabrication process chain.Copyright © 2015 by ASME

Traditional methods of correcting malunited distal humeral fractures in children involve complex wedge osteotomies held with pins or internal fixation devices. These require a large exposure and challenging fixation. We elected to perform simple transverse osteotomies, without wedges, using a lateral incision. These were maintained by the small AO external fixator. Between 1987 and 2004, five children with malunited distal humeral fractures were treated. Angular and rotational correction was obtained in each case. Bony union occurred at an average of 8 weeks. A simple osteotomy held by the small AO external fixator provides accurate correction, precise adjustability, and solid stability.

The treatment of distal radius fractures has changed over the last several decades as understanding of these common injuries has grown [1–4]. We have come to appreciate that pain and dysfunction following distal radius fracture are not as uncommon as was once believed [5–7] .W e have recognized that the degree to which preinjury anatomy is restored has a real bearing on the outcome of treatment [8–12]. At the same time, our patients, particularly those in the sixth decade and beyond, have grown more active and have developed higher expectations regarding their recovery. One need only look at the number of new devices marketed for the treatment of distal radius fractures over the last decade to realize the obvious change in attitude that has occurred concerning the treatment of these injuries. Although internal fixation devices have dominated the marketplace recently, advances also have been made in the technology of external fixation. As we consider the treatment of these injuries, we must remember that the specific device or surgical technique is, after all, only a means to an end. The continuing challenge remains the selection of the most appropriate method of treatment for a given fracture.

Most commonly seen in the knee, elbow and ankle, osteochondritis dissecans (OCD) represents an underlying bony fragment separation from the subchondral region with or without articular involvement. Osteochondral or chondral injuries are associated with trauma and can occur in any joint. Unstable OCD and traumatic osteochondral or chondral lesions demand operative treatment, particularly if displaced. Principles of treatment include anatomic reduction, rigid fixation, enhancement of blood supply, and restoration of articular congruity. Internal fixation can be achieved through open or arthroscopic approaches with one of many devices including cannulated screws, metal pins, and bioabsorbable pins. Cannulated screws can provide rigid fixation and compression across lesions. AO screws must eventually be removed to avoid articular damage and allow weightbearing. Headless, variable pitch screws, however, can be placed below the articular margin, do not need to be removed, and provide compression because of their differential pitch designs. Metal pins in the form of Kirschner wires (K-wire) can be placed antegrade through the lesion, or retrograde from behind the lesion. K-wires can potentially migrate, bend or break, and they must eventually be removed. Bioabsorbable pins have several advantages including bioresorbable properties obviating the need to remove them, low-profile designs, and a decrease in stress-shielding compared with metal implants. The most common reported complication with bioabsorbable pins is a reactive synovitis. Newer devices recently described for OCD lesions of the capitellum include pull-out wires and dynamic staples. The purpose of this article is to present different options for operative fixation of these lesions.

SummaryThe treatment of distal humeral fractures has evolved over the past several decades. Due to advances in surgical techniques, as well as internal fixation devices, open reduction and internal fixation for an adult distal humeral fracture is now the rule rather than the exception. As the number

Fracture dislocations around the wrist are managed either by scaffolding it with a plaster or with internal fixation devices. The present video below presents forward a third option i.e. Closed ligamentotaxis with ilizarov frame. This is an extremely simple, atraumatic and wonderful solution. Keywords: Radial fractures, Ilizarov technique.

The treatment of distal radius fractures has evolved over the past few years because of both new techniques of fracture fixation and bone graft substitutes, as well as a refined appreciation of the factors that most affect functional outcome. Despite the ongoing development of new external and internal fixation devices, satisfactory motion and grip strength can be restored if certain fundamental principles of management and surgical technique are followed

Dorsally displaced fractures of the distal radius fractures are one of the commonest in day-to-day practice. There is still no consensus among surgeons regarding the suitability of using volar or the dorsal cortex as basis for internal fixation for dorsally displaced fractures. We report an anatomical study, which compares the thickness of the volar and dorsal cortices of cadaveric adult radii using digital photography. Results of this study show that the volar cortex was statistically, significantly thicker than the dorsal cortex. We believe that the volar cortex may behave as the calcar of the distal radius and hence internal fixation devices applied to the volar cortex may provide a more stable internal fixation compared to those based on the dorsal cortex.

Despite the widespread use of rigid fixation techniques in craniofacial surgery, there is a paucity of studies in the literature that serve to better define the reasons for the subsequent removal of plates and screws. The current study appears to be the first to attempt to assess these issues among a broad range of craniofacial surgery patients. Fifty-five patients who underwent hardware removal following craniofacial surgery at the University of Michigan Medical Center between 1989 and 1995 were retrospectively studied via an in-depth chart review. Common reasons for hardware removal included palpable/prominent hardware in 19 patients (34.5%), loosening of plates and screws in 14 patients (25.5%), pain in 14 patients (25.5%), infection in 13 patients (23.6%), wound dehiscence/exposure of hardware in 11 patients (20%), and removal at the time of secondary procedures in 5 patients (9.1%). It is hoped that this study will serve as a tool to define more completely the risk of needing subsequent hardware removal among craniofacial surgery patients treated with rigid internal fixation.

Internal fixation devices continue to be used in the fixation of foot and ankle fractures and osteotomies. Because of the increased use of fixation techniques, postoperative care following removal of internal fixation devices assumes a vital role in the success of these procedures. Using 10 fibulas from 5 cadavers, the authors tested the resistance of 5 intact fibulas and 5 contralateral fibulas with one 3.5-mm. drill hole to bending forces. The mean load at failure of the intact fibulas was 360.86 N (range 181.69–800.14 N), whereas the mean load at failure of the drilled fibulas was 215.20 N (range 66.49–600.61 N). The drilled fibulas displayed failure with the application of 59.63% of the mean load applied to the intact fibulas at failure ( p = 0.007).

Fractures of the distal femur are severe traumatic injuries that are treated with the utilization of internal fixation devices. Current preclinical device designs have primarily been investigated without observance of femoral muscle group effects — in addition to joint hip reaction forces — and irregular geometry of the human femora. This has led to a need to optimize the performance and fit of internal fixation devices to produce maximal reliability and structural integrity. The present study utilizes a systematic design approach that employs computer-aided modeling, robust design methodology, finite element methods, and optimization processes for a femoral locking plate system. In doing so, a computer-aided model was constructed to illustrate a distal femoral fracture fixation system. Femoral muscle force directions and magnitudes associated with a normal walking gait cycle were inputted into the system to simulate realistic loading conditions. In conjunction with finite element methods, the model was used to assess stress and strain distributions along the femur, femoral plate, and screws. Subsequently, optimization processes were then employed to assess the effects of varying device geometric parameters and bone topology on the bone-implant stress distributions and overall device design. The proposed simulation-based optimization process was able to yield a more accurate representation of the biomechanics within the bone-implant interaction by taking into consideration the substantial effects of femoral muscle groups. In doing so, a robust device design is developed which improves overall performance via minimizing weight and maximizing overall factor of safety.Copyright © 2013 by ASME

Each year, there are over six million bone fractures in the U.S., over 30% of which require internal fixation devices to stabilize bone fragments during healing [1–2]. Currently, the gold standard materials for these devices are non-degradable titanium alloys. Unfortunately, these devices cause numerous complications and often require a secondary invasive removal surgery [3–4]. To circumvent these issues, resorbable polymeric devices have been developed, but their mechanical limitations render them inadequate for most load bearing applications [5–7].Copyright © 2013 by ASME

Limited data are available on the use of internal fixation in combat zone hospitals. The authors performed a retrospective review of 713 surgical cases during 2 Operation Enduring Freedom deployments to a Level III theater hospital in 2007 and 2009 to 2010. The epidemiology and short- to intermediate-term outcomes of patients treated with internal fixation devices were studied. The authors found that, with judicious use, internal fixation under a damage control protocol in a combat theater hospital can be performed with acceptable complication rates.

The zygoma, or malar bone, is an aesthetically important prominence within the overall structure of the face. It is a ready target for both intentional and accidental trauma. Optimal repair of injuries involving the "malar complex" requires precise open fracture reduction and placement of rigid internal fixation devices through concealed incisions. Surgical approaches to the malar complex and techniques of reduction and rigid fixation of malar injuries are presented.

OBJETIVO: Medir o volume ocupado pelos dispositivos de fixação interna mais difundidos para o tratamento das fraturas de colo femoral, usando como aproximação os primeiros 30, 40 e 50mm de cada parafuso. O estudo visa observar qual desses implantes causa menor agressão óssea. MÉTODOS: Foram avaliados cinco modelos de parafusos canulados e quatro modelos de parafusos deslizantes (DHS) encontrados no mercado nacional através de diferença de volume por deslocamento de água. RESULTADOS: A fixação com dois parafusos canulados apresentou volume significativamente menor do que com DHS nas inserções de 30, 40 e 50mm (p=0,01, 0,012 e 0,013, respectivamente), a fixação com três parafusos não apresentou significância estatística (p=0,123, 0,08 e 0,381, respectivamente) e a fixação com quatro parafusos canulados apresenta volumes maiores que o DHS (p=0,072, 0,161 e 0,033). CONCLUSÕES: A fixação da cabeça femoral com dois parafusos canulados ocupa menor volume quando comparada ao DHS com diferença estatisticamente significativa. A maioria das outras combinações de parafusos não atingiram significância estatística, apesar de a fixação com quatro parafusos canulados apresentar, em média, volumes maiores que o ocupado pelo DHS. OBJECTIVE: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. METHODS: Five types of cannulated screws and four types of dy namic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displace ment. RESULTS: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixa tion with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixa tion with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). CONCLUSIONS: Fixa tion of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws pre sented larger volumes on average than those occupied by DHS.

A simple, inexpensive, and rigid technique for occipitocervical fixation was evaluated in 14 patients with occipitocervical instability. Posterior arthrodeses of the occipitocervical region were performed using pelvic reconstruction plates and screws as internal fixation devices. At follow-up, which averaged 11.7 months, all patients had fused with minimal complications. This versatile technique, readily adapted to complex deformities and extensible for subaxial fixation, was reviewed.

Stainless steel is one of the most widely used biomaterials for internal fixation devices, but is not used in cementless arthroplasty implants because a stable oxide layer essential for biocompatibility cannot be formed on the surface. We applied a Ti electron beam coating, to form oxide layer on the stainless steel surface. To form a thicker oxide layer, we used a microarc oxidation process on the surface of Ti coated stainless steel. Modification of the surface using Ti electron beam coating and microarc oxidation could improve the ability of stainless steel implants to osseointegrate.The ability of cells to adhere to grit-blasted, titanium-coated, microarc-oxidated stainless steel in vitro was compared with that of two different types of surface modifications, machined and titanium-coated, and microarc-oxidated.We performed energy-dispersive x-ray spectroscopy and scanning electron microscopy investigations to assess the chemical composition and structure of the stainless steel surfaces and cell morphology. The biologic responses of an osteoblastlike cell line (SaOS-2) were examined by measuring proliferation (cell proliferation assay), differentiation (alkaline phosphatase activity), and attraction ability (cell migration assay).Cell proliferation, alkaline phosphatase activity, migration, and adhesion were increased in the grit-blasted, titanium-coated, microarc-oxidated group compared to the two other groups. Osteoblastlike cells on the grit-blasted, titanium-coated, microarc-oxidated surface were strongly adhered, and proliferated well compared to those on the other surfaces.The surface modifications we used (grit blasting, titanium coating, microarc oxidation) enhanced the biocompatibility (proliferation and migration of osteoblastlike cells) of stainless steel.This process is not unique to stainless steel; it can be applied to many metals to improve their biocompatibility, thus allowing a broad range of materials to be used for cementless implants.

Rigid internal fixation devices are a mainstay in craniofacial surgery. The advent of absorbable plates has been a monumental advancement and has proven to be a safe and effective method of osteofixation. It has been proposed that many problems of the permanent metallic implants can be avoided by the use of resorbable plates. Exposure is thought to be secondary to tissue tension over the plates and breakdown of the overlying tissue envelope. This a report of 2 cases of craniosynostosis reconstruction with absorbable plate exposure through overlying skin incisions necessitating plate removal and revisionary surgery. This study proposes that imprudent plate placement traversing overlying skin incisions may more likely result in absorable hardware exposure. Careful preoperative planning of skin incisions and proposed hardware placement are a strategy to avoid absorbable plate exposure in craniosynostosis reconstruction.

Metastatic involvement of the femur is a common clinical problem and accounts for the third highest incidence after the spine and pelvis. These patients are confronted with the possibility of losing the ability to ambulate during their remaining months. However, with improved prosthetic implants and internal fixation devices, most patients can resume their previous activities after operative treatment of their femoral fractures.

Fifteen years ago, writing an article with the title “Management of Mandibular Fractures” would have been a much easier task than it is today. Few areas of otolaryngology/head and neck surgery have experienced changes of the magnitude of those impacting on the management of maxillofacial trauma. A comprehensive review article on the subject of mandibular fractures will necessarily reflect the several biases of the author. As one with extensive experience in the successful application of conventional, prerigid fixation techniques to mandibular fractures, I was slow to accept the new hardware. Early published reports of results by surgeons in the United States documented complication rates that were unacceptable to me. I was confident that surgeons with limited traditional experience were too quick to adopt systems more exacting and unforgiving than those not yet mastered. In truth, I still believe that many of my fears and misgivings have basis in fact. Nevertheless, rigid internal fixation devices are here to stay and are now the treatment of choice for several types of mandibular fractures.

Summary With the advent of locking screws fixation devices, came new problems when removing internal fixation hardware. The objective of this study was to evaluate these problems and their possible solutions. The first problem was screws jamming on the plate, secondary to either initial poor screwing technique (with inadequate placement of the targeting device) or use of excessive force (when screwing in the screws without using the torque-controlling screwdriver). Treatment consists of destroying the screw heads using tungsten drills. The screw bodies can then be extracted using a trephine drill. The second problem involves destruction of the recess of the screw head. It can be secondary to overly forceful screw insertion or risky screw extraction. This can be treated using a specific conical left-turn screwdriver, assuming that the screw/plate thread is still intact. Finally, the screw recess can be filled. The plate itself may be a source of problems when being extracted because the screw holes left free also have been filled. Lever arm maneuvers to raise the fibrous bridges and substantial traction along the axis can be useful. These problems are more frequent with minimally invasive surgery. The consequences of this fixation type's hardware removal surgery are multiple: lengthened operative time, risk of secondary maximally invasive surgery, presence of metallic shavings residues in cases of screw head destruction, and the risk of iterative fracture secondary to trephine drill use. Prevention is thus essential. It is based on rigorous technique in placing the targeting device, drilling, and inserting screws, the systematic use of the torque-controlling screwdriver, and the verification of proper screw position. The locking compression plate (LCP) material is highly effective but its removal should not become challenging. Level of evidence Level V.

The authors review the properties and podiatric applications of biodegradable internal fixation devices. These devices include sutures, rods, and screws. Fixation of fractures and osteotomies with absorbable materials has been shown to be as effective as fixation with more traditional means, and it also provides several advantages.

Malignant tumors of the lower oral cavity with infiltration of the mandible frequently require segmental bone resections. The resulting loss of continuity in the mandibular arch causes a significant functional and esthetic deficit. A decisive step in the improvement of quality of life in these patients was the development of alloplastic defect bridging devices. Various techniques and materials can be applied.1–8