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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents
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Fracture patterns of two sagittal split ramus osteotomy techniques: a cadaveric study.

A P G R Couto1, A L R de Ribeiro2, L H S Guimarães1

  • 1Department of Oral Pathology, School of Dentistry, Federal University of Pará, Av. Augusto Correa 01, Belém, PA, Brazil.

International Journal of Oral and Maxillofacial Surgery
|April 22, 2026
PubMed
Summary

The Wolford technique for sagittal split ramus osteotomy (SSRO) resulted in fewer unfavorable fractures compared to the Epker technique. This modification enhances fracture predictability in correcting dentofacial deformities.

Keywords:
Mandibular osteotomyMaxillofacial surgeryOrthognathic surgeryOsteotomySagittal split ramus osteotomy

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Biomechanical Engineering
  • Anatomical Studies

Background:

  • Sagittal split ramus osteotomy (SSRO) is a standard surgical procedure for correcting dentofacial deformities.
  • Variations in SSRO techniques may influence surgical outcomes and fracture patterns.
  • Understanding biomechanical differences is crucial for optimizing surgical predictability.

Purpose of the Study:

  • To compare the Epker and Wolford techniques for sagittal split ramus osteotomy (SSRO).
  • To evaluate differences in fracture patterns, biomechanical load, displacement, and time.
  • To assess the impact of mandibular thickness on fracture outcomes.

Main Methods:

  • Ex-vivo biomechanical testing of 61 adult cadaveric mandibles.
  • Random assignment of hemimandibles to Epker or Wolford SSRO techniques.
  • Application of tensile load using a modified Smith sagittal separator until fracture failure.
  • Classification of fractures using the Lingual Split Scale (LSS).

Main Results:

  • The Epker technique showed a significantly higher relative risk (4.51-fold) of unfavorable fractures (LSS4) compared to the Wolford technique (P = 0.027).
  • No significant differences were observed between techniques in maximum tensile load, displacement, or fracture time (P > 0.05).
  • Mandibular thickness did not significantly influence fracture patterns (P > 0.05).

Conclusions:

  • The Wolford SSRO technique, with an additional inferior mandibular rim cut, demonstrates increased fracture predictability.
  • This modification may reduce the biomechanical load required for mandibular splitting, potentially improving surgical outcomes.
  • The findings suggest the Wolford technique offers advantages in controlling fracture patterns during SSRO procedures.