Conventional two plate fixation versus L-shaped plates in management of mandibular angle fracture: A comparative retrospective study

Purpose: In mandibular angle fractures, various treatment modalities have been used to rigidly fix the fractured segments aiming to achieve healing through stability and bone formation. In this study, a comparison between two fixation techniques was implied; one L-shaped plate versus two horizontal plates superiorly and inferiorly placed respectively, in an attempt to assess their different effect on healing and complications.
Materials and methods: Sixteen patients suffering from displaced angle fractures were included in this study with a mean age of 42 years. The selected patients were divided into two equal groups; Group A employed the fixation of the fractured segments using one L-shaped plate and Group B used the conventional treatment method of utilizing two horizontal plates to fix the fragments in their normal position with subsequent immediate postoperative mandibular function. All the patients were followed-up at minimum period of evaluation of six months. Postoperative complications were recorded if present which included fragment mobility, changed occlusion, dehiscence, infection and/or parasthesia. Postoperative clinical assessment through pain evaluation via visual analogue scale (VAS; scale 0-10) and maximal non-assisted inter-incisal mouth-opening (MIO) measured in mm was performed. Plain radiographic views were performed for inter-fragment alignment assessment. Clinical readings were recorded immediately postoperative and on months 1 and 3. The collected clinical and radiographic findings were tabulated and statistically analyzed.
Results: The healing in all cases was uneventful and all patients showed clinical success with no sign of fragments mobility. All the data were analyzed by Mann Whitney U test to compare between the tested groups. Friedman test used to compare between follow up periods followed by Wilcoxon signedrank test for pair wise comparison. The clinical examination and the radiographic assessment revealed no statistically significant difference between the readings of both groups. Regarding the postoperative complications, better initial results came in favor of group A patients, however, with no difference between both groups at the end of the follow up period.
Conclusion: Despite of the displacement of the segments in mandibular angle fractures, this study stated that no significant benefit in MAF healing was seen when different plating techniques were used, under the condition of utilizing more than one plane in plate fixation. However, the
one-plate L-shaped fixation technique presented fewer postoperative complications.