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b. Plate Osteosynthesis
Plate fixation can be a “load-bearing” or “load-sharing” osteosynthesis
(Figure 5.14).
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Figure 5.14
The upper image
demonstrates a load-
bearing plate used when
the bone cannot bear the
functional forces. In the
lower image, the bone
stock is sufficient to help a
smaller load-sharing plate
bear these forces.
i. Load-Bearing Osteosynthesis
Load-bearing osteosynthesis requires a rigid plate to bear the entire
force of movement at the fracture during function. Load-bearing plates
are indicated for comminuted fractures and fractures of atrophic
edentulous.
ii. Load-Sharing Osteosynthesis
Load-sharing osteosynthesis creates fracture stability with shared
buttressing by significant bone contact and the plate used for fixation.
This requires adequate bone stock at the fracture site to create resis-
tance to movement. Examples of load-sharing osteosynthesis include
lag-screw fixation,
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compression plating, and a miniplate fixation
technique popularized by Champy.
34
Load-sharing osteosynthesis
cannot be used in comminuted or atrophic edentulous fractures
because of lack of bone buttressing at the site.
Ellis demonstrated that load-sharing miniplate fixation had markedly
less major complications than a rigidly fixated load-bearing fixation.
37,56
Singh found no significant difference in incidence of complications in
mandible fractures treated with the Champy miniplate technique or
3-dimensional miniplate fixation.
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4. Surgical Treatment
Information about surgical treatment can be found on the AO
Foundation’s (Davos, Switzerland) Web site
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and other sites.