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Complications of rigid internal fixation.

Chris A Campbell¹, Kant Y Lin

¹Department of Plastic Surgery, University of Virginia Health System, Charlottesville, Virginia.

Craniomaxillofacial Trauma & Reconstruction

|November 24, 2011

Summary

Craniomaxillofacial surgery fixation systems have evolved, shifting complications from instability to infection and palpability. Newer systems aim to reduce these risks, but challenges remain, especially in pediatric patients.

Keywords:

Rigid internal fixation complications craniofacial craniomaxillofacial trauma facial fracture

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Area of Science:

Orthopedics
Neurosurgery
Plastic Surgery

Background:

Bone fixation systems in craniomaxillofacial surgery have advanced over 20 years.
Technological evolution has led to new complications, such as infection and palpability with plate and screw systems.

Purpose of the Study:

To review complication rates of various bone fixation systems.
To compare miniplating, microplating, and resorbable plating systems in craniofacial surgery.

Main Methods:

Review of reported complication rates.
Analysis of systems including miniplates, microplates, and resorbable plates.
Inclusion of both elective and traumatic craniofacial surgery cases.

Main Results:

Traditional wiring complications (instability) replaced by exposure, infection, and palpability with rigid plates.
Rigid plates require precise anatomic alignment; failure leads to "open internal fixation" without reduction.
Smaller plates face limitations due to masticatory forces and bone healing; pediatric use can cause migration and growth restriction.
Resorbable plates offer reduced palpability and inflammation but can still cause growth restriction.

Conclusions:

Complication profiles have shifted with advancements in fixation technology.
Rigid fixation systems necessitate accurate reduction, while resorbable systems present their own challenges, particularly regarding growth in pediatric patients.