This document discusses different plating systems used in maxillofacial trauma. It describes the goals of fracture fixation as reduction of bone fragments, stable fixation, preservation of blood supply, and early functional mobilization. It then explains several plating systems in detail, including miniplate fixation, microplate fixation, compression plates, locking plates, reconstruction plates, and bioresorbable plates. Each system is outlined in terms of its advantages and disadvantages for fracture management.

1. PLATING SYSTEMS IN
MAXILLOFACIAL TRAUMA

2. Healing process in fractures

3. Modes of fracture healingBasedonmechanical
environment
DIRECT
CONTACT
HEALING
GAP HEALING
INDIRECT

4. Fracture fixations

6. Load bearing system
 plate bears the functional
load at the fracture site
 accomplished with a locking
reconstruction plate.
 Clinical uses are the
management of atrophic
edentulous fractures,
comminuted fractures and
complex mandibular
fractures.

7. Load sharing system

8. RIGID and SEMIRIGID FIXATION
 Does not allow micromotion of fracture segments during
functional movements
 Absolute rigid fixation not necessary for successful healing
(Selection of Internal Fixation Devices for Mandibular Fractures: How Much Fixation
Is Enough? Edward Ellis Seminars in Plastic Surgery 2002; 16(3): 229-240
DOI: 10.1055/s-2002-34430)
 Additional plates required to establish absolute rigidity-
increases complication rate
(Ellis, Edward, and Lee R. Walker. "Treatment of mandibular angle fractures using
one noncompression miniplate." Journal of oral and maxillofacial surgery 54.7
(1996): 864-871.)

9. GOALS OF FIXATION
 REDUCTION OF BONE FRAGMENTS
 STABLE FIXATION
 PRESERVATION OF BLOOD SUPPLY
 EARLY FUNCTIONAL MOBILISATION

10. PLATING SYSTEMS
 MONOCORTICAL MINIPLATE FIXATION SYSTEM
 MICROPLATE FIXATION
 COMPRESSION PLATES
 LOCKING PLATES
 RECONSTRUCTION PLATES
 BIODEGRADABLE PLATES

11. MINIPLATE FIXATION SYSTEM
 MITCHEL et al 1960s, CHAMPY et
al 1976
 Goal-to provide stable fracture
reduction without interfragmentary
compression or MMF
 Advantages-reduced size, smaller
incisions and less tissue
dissection,less paplpable, reduced
necessity of removal
 screws are monocortical – can be
placed in areas adjascent to tooth
roots with minimal risk of injury

12.  Disadvantages
 Decreased rigidity- torsional movements under
functional loading
 Cannot be used in comminuted fractues
 Functional restriction recommended

14. MICROPLATE FIXATION SYSTEM
 Muscular forces on midface skeleton are much less
 Thinner and malleable microplates used
 Low profile- advantageous in areas of minimum
overlying soft tissue
 Application through smaller incisions in aesthetically
sensitive areas

15.  Can be used for fixation of bones in
 Cranium , orbital rim, zygomatic process, anterior
maxilla and NOE complex

16. Compression plating system
 load-sharing osteosynthesis –dynamic,eccentric dynamic
 EDCP- used when tension band not possible-edentulous,
impacted third molar,avulsion of bone from fracture
 ensures good interfragmentary compression and thus
good bony buttressing

18.  As the eccentrically placed compression screws are
tightened, the head moves down the ramp and the bone
is compressed together

19. Plate must be slightly overbent
To close lingual gap(1-2mm)

20.  Indicated in nonoblique fractures with good bony
apposition after reduction
 Disadvantages- technique sensitive,plate should be
precisely adapted to bone
 Use in oblique fractures- can lead to overriding
segments

21. Locking plate system
Plates have threaded holes-thus two separate points of
fixation for each screw

22.  Screw locks to plate independent of bone-fracture stability
without direct bone contact
 Thus precise plate adaptation not manadatory
 More viable periosteum as plate does not compress bone
 Minimises complications with loose screws
 Can be used in severe oblique fractures, comminuted
fractures and fractures with bone loss

23. Reconstruction plates
 Load bearing
 In cases of bone loss, gross instability or severe
comminuted fractures, edentulous atrophic mandibles
 The plate must be long enough so that there can be a
minimum of three or preferably four screws on each side
of the fracture.
 The screws adjacent to the fracture should be at least 7
mm away from the fracture line.

24. Bioresorbable plating system
 Metallic plates- growth restriction and plate translocation
 Bioresorbable plates- SR-PLA, SR PGA
 Advantage-iitial rigid fixation.as bone heals-plate
resorbs, reduces stress shielding effect
 Disadvantages-long resorption time, sterile fluid
accumulations have been reported, less stable than
conventional systems