Resident Manual of Trauma to the Face, Head and Neck

b. Plate Osteosynthesis Plate fixation can be a “load-bearing” or “load-sharing” osteosynthesis (Figure 5.14). 55

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, 56 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. 57 4. Surgical Treatment Information about surgical treatment can be found on the AO Foundation’s (Davos, Switzerland) Web site 55 and other sites.

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