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.
  • Than the ends of both wires twisted together for their entire length.
  • So that the strong base wires is formed on either side, coming towards midline from each second molar.
• The excess wire is cut and the ends are checked in inter dental space.
• The base wire is secured to individual tooth by using additional inter dental wires.
• The one of small wire 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 mesial interdental space above the base wire.
• Both ends are again grasped together and twisted, cut and fiished in 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.

• There are many types of arch bars available.
• Rigid types are made by half round stainless steel wire of 18 and 21 gauge.
• The read-made arch bars are available (Erich arch bar)
• These are consider bettr as these 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 arch cannot be secured due to poor periodontal condition of 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 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 progressing to midline and fiishing on other end.
• 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 ligature wire passed around each individual tooth.
• One end of the wire coming below the arch bar and above it in the buccal side and then fiished.
• Care is taken that hooks on the arch bar are directed upward in the maxilla and downward in mandible

• 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 lower border wiring is done by extraoral approach.
• The edges ofbony fragments are cleaned and reduced with the help of “Bone-holding” device.
• Holes are drilled in the bone using an electric or “hand drill”.
• Drilling is done under constant jet of normal saline solution.
• The holes should be drilled at a distance of atleast 5 mm from the fractured site.
• A no 26-gauge wire is passed through the holes across the fracture line and tightened by trusting 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 osteosynthesis lines should be established.
  • The adaptation of the bone plate is done by bending pliers.
• Adapted bone plate should lie passively over the contour of 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 fracture is present between the canine and premolars, mental 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 nerve to lower level may be indicated.
  To reduce the effect of torsional forces in symphysis region between 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.