Fracture Reduction – Types, Procedure, Recovery And Risks

Fracture Reduction – Types, Procedure, Recovery, And Risks

• Direct wiring:
  • Direct interdental wiring
  • Eyelet
  • Continuous or multiple-loop wiring
  • Risdon’s wiring.
• Arch bars:
  • Erich
  • German silver
  • Jelenko.

• Intermaxillary fiation:
  • Dental wiring:
    • Direct Interdental
    • Eyelet
    • Continuous or multiple loop wiring
    • Risdon’s wiring.
  • Arch bars:
    • Erich
    • German silver
    • Jelenko.
  • Cap splints.
• Intermaxillary fiation with osteosynthesis:
  • Transosseous wiring
  • Circumferential wiring
  • External pin fiation
  • Bone clamps.
• Osteosynthesis without intermaxillary fiation:
  • Non-compression small plates
  • Compression plates
  • Mini plates.

• Use when all teeth are present.
• A 26 gauge, 25 cm long wire is passed around the neck of the 2nd molar on each side so that both ends of wire extend to buccal side.
  • Then the ends of both wires were twisted together for their entire length.
  • So that the strong base wires are formed on either side, coming towards the midline from each second molar.
• The excess wire is cu,t and the ends are checked in the interdental space.
• The base wire is secured to the individual tooth by using additional interdental wires.
• One of the small wires is passed from the distal surface of the tooth below the base wire and brought out towards the lingual side, and then brought out on the buccal surface from the mesial interdental space above the base wire.
• Both ends are again grasped together and twisted, cut, and finished in the interdental space.
• Each tooth is engaged in the same manner to the base wire,so that the base wire is fully secured to the dental arch.
• Two types of horizontal wiring after strong fiation and prevent supraeruption.

Fracture Reduction Procedure

• There are many types of arch bars available.
• Rigid types are made by half-round stainless steel wire of 18 and 21 gauge.
• The ready-made arch bars are available (Erich arch bar)
• These are considered better as they are soft, easy to adapt, and have hooks.
• The arch bars are indicated when there are not enough teeth in the arch for conventional Risdon’s wiring or when all teeth in the arch cannot be secured due to poor periodontal condition of the teeth.
• The arch bar should be perfectly adapted to the teeth in the arch because if the bar is not fitd, it can cause orthodontic movement.
• The arch is adapted by starting from the distal-most point in the arch.
• A sharp bend is given at the edge of wire to be pushed into the interdental space between 2nd and 3rd molar to avoid slippage of arch bar.
• It is adapted to progress to midline and finish on the other end.
• The arch bar should not cross the fracture line.
• The bar should be cut and adapted to each fragment, separating.
• The arch bar is secured in place by using a ligature wire passed around each tooth.
• One end of the wire comes below the arch bar and above it, the buccal side, and then finishes
• Care is taken that hooks on the arch bar are directed upward in the maxilla and downward in the mandible.

Fracture Reduction Recovery Time

• There are two method of wiring: The upper border wiring and lower border wiring, in case of angle and body of the mandible.
• The upper border wiring is done intraorally just below the alveolus, and the lower border wiring is done by an extraoral approach.
• The edges of bony fragments are cleaned and reduced with the help of a “Bone-holding” device.
• Holes are drilled in the bone using an electric or “hand drill”.
• Drilling is done under a constant jet of normal saline solution.
• The holes should be drilled at a distance of at least 5 mm from the fractured site.
• A 26-gauge wire is passed through the holes across the fracture line and tightened by twisting the two ends.

• In multiple mandibular fractures, accurate reduction and establishment of normal occlusion is tuf, so it is advisable to secure the normal occlusion through interdental wiring before the miniplate osteosynthesis is performed.
• Following reduction, the osteosynthetic lines should be established.
  • The adaptation of the bone plate is done by bending pliers.
• The adapted bone plate should lie passively over the contour of the external cortex, and it is confirmed that there should not be any gap between the plate and the bone.
• The miniplate is fied in its specifi position with the screws.
• In fractures of the angle of the mandible, plate is located on the posterior fragment, medial to the external oblique line, this is done so that it can be bent over the surface and the posterior screws are placed in sagittl direction.
• In cases with simultaneous fractures of the alveolar process or if impacted third molar teeth are present, the plate may be fied to the outer surface of the mandible which correspond to the position in the course of line of tension.
• When the fracture is present between the canines and premolars, the ental nerve may be damaged by applying the plate. In such cases, it is recommended to place concave section of plate between screw holes precisely at the exit point of the nerve.
• In some of the very exceptional cases, transposition of the nerve to a lower level may be indicated.
  To reduce the effect of torsional forces in the symphysis region between the mental foramina, it is mandatory to use two parallel plates.
• In the cases of comminuted fractures or in cases where there are detached triangular pieces of bone, longer plates with six or more screws should be used.