RESULTS OF TREATMENT OF FRACTURES OF THE ATROPHIC EDENTULOUS MANDIBLEBY COMPRESSION PLATING - A RETROSPECTIVE EVALUATION OF 84 CONSECUTIVECASES

Purpose: This article introduces a simple and reproducable classificat ion of the degree of atrophy in fractures of the atrophic edentulous m andible, and evaluates the results of treatment in 84 consecutive frac tures based on this classification. Material and Methods: Eighty-four fractures of the edentulous mandible, with a height at the fracture si te of less than or equal to 20 mm, were included. Using the ratio of a ctual plate width to plate width on the postoperative radiograph, the actual height of the mandible at the fracture site was calculated. Twe nty-five fractures (30%) were in the Class I atrophy group (height at the fracture site 16 to 20 mm), 33 fractures (39%) occurred in Class I I atrophic mandibles (height 11 to 15 mm), and 26 fractures (31%) were seen in extremely atrophic Class III mandibles (height less than or e qual to 10 mm). The treatment was performed by compression plating wit hout any postoperative MMF. Primary bone grafting was used in six case s (7%) because a partial bony defect was present at the fracture site. Results: In 81 (96.5%) of the 84 fractures an uncomplicated, solid, b ony union was achieved. Three major complications occurred: one osteom yelitis and two nonunions. The two nonunions occurred in bilateral fra cture of an extremely atrophied mandible (Glass III atrophy). Minor so ft tissue infections, without interference with fracture healing, were observed in six cases (7%). Conclusions: Because there is an obvious relation between the height of the mandible and the incidence of compl ications in fracture healing, a special classification of the degree o f atrophy is needed. In fractures of the extremely atrophic mandible ( Class III atrophy) periosteal degloving should be avoided and supraper iosteal placement of plates is recommended. Compression osteosynthesis has proved to be a successful method, with minimal impairment of the patient and a low frequency of serious complications.