Killey And Kay Mandibular Fracture Pdf Download ((HOT))

Results: A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p

Conclusions: Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.

Killey And Kay Mandibular Fracture Pdf Download

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A total of 390 patients, diagnosed with facial fractures, were seen at KTDH; 14.1 % (55) were children below 16 years of age with the mean age of 10 years (SD 3.9). The ratio of males to females was 2.2:1. Most fractures were due to road traffic accidents (RTA) 56.4 %, followed by daily living activities 21.8 % and assault 16.4 %. The most prevalent anatomic sites of fractures were mandible 77 %; combination fractures i.e. more than one site 32.7 % and zygomatic-complex (13.5 %). Concomitant injuries were found in 9.1 %. Almost half of the patients were managed conservatively 49.1 %, closed reduction 34.5 % and surgical open reduction 16.4 %.

The findings of this study indicated that pediatric facial fractures constitute 14.1 % of the total number of facial fractures. RTA was the main cause, which should be considered in legislative and preventive strategies.

Trauma is one of the leading causes of mortality and morbidity among children [1]. Trauma in children is usually accompanied with special complications such as the risk of growth disturbances, facial asymmetry e.g. temporomandibular joint ankylosis, and growing skull fracture [2]. Trauma-induced maxillofacial injuries in children may affect function as well as esthetic. They must be diagnosed promptly and managed appropriately to avoid disturbances of future growth and development.

Diagnosis and management of pediatric facial fractures is sometimes difficult compared to adults. It requires special attention to several critical factors related to anatomical, physiological and psychological development as well as the complications of trauma. Thus management techniques should be modified to address these special characteristics of pediatric facial fractures. This study aimed to describe the pattern and etiology of facial fractures in Sudanese children below 16 years.

Mandibular fractures were classified according to Killey: condyle, ramus, angle, body, symphsyal and parasymphsyeal [8]. The mid-facial fractures sites were classified as: Le Fort (including all levels), zygomatic complex, naso-orbital-ethmoid (NOE) and others. Dentoalveolar fractures and other dental injuries were excluded.

Most maxillofacial fractures among children were caused by RTA 56.4 %, followed by daily activities 21.8 %, assault 16.4 %, and others 5.5 %. Pediatric facial fractures caused by RTA were consistently increasing with age. There was a significant relationship between the age and etiology of facial fracture (P = 0.003). Table 1. Males sustained 77.7 % of facial fractures which were due to assault Table 2.

Seventy four pediatric facial fractures were sustained in 55 patients. These were due to combination fractures (more than one fracture in one patient) and occurred in 32.7 % patients. Most of the facial fractures occurred in the mandible 76.8 %, followed by mid-face fractures; zygomatic complex fractures 13.5 %, Le Forte 6.7 % and NOE 1.3 %.

In this study 14.1 % of the patients presenting with facial fractures were children. This figure is consistent with other studies from different parts of the world, where facial fractures in the pediatric population are reported to be less than 15 % of all facial fractures worldwide [4, 10, 11].

RTA was the most common etiological factor of facial fractures in this study as shown in Table 3. This is explained by the fact that Khartoum city is facing heavy traffic problems as there is an increasing number of cars (a car for each 120 citizens) coupled with badly maintained roads. This is further complicated by the mechanical condition of the cars, and few pedestrian bridges and crossings. The most recent report has estimated that there were around 44442 RTA in Khartoum state in the year 2009 [18]. This rise of RTA was explained by Kaban who described how RTA has increased in recent years, although falls and assaults remain steady [11, 16, 17]

Daily living activity (playing, falls) was the second most common etiological factor. It occurred mostly in children below the age of 6 years. There was one patient in whom the fractures were caused by an animal (donkey). Another two cases were due to falling into a well while they were collecting water. These cases were peculiar to rural areas where children participate in the community activities and work. These are consistent with other studies that reported young children are prone to sustain injuries from low-velocity forces (e.g. falls), while older children are more likely to be exposed to high-velocity forces (e.g. RTA) [5, 17, 19].

Assaults and interpersonal violence as causative factors of facial fractures were seen in 16.4 % of the children. These are uncommon causes of facial fractures in children, but when they occur they are commonly seen in the older age groups as confirmed in this study. In addition, they mostly occur among males. This indicates an increasing frequency of assault-related accidents in this age group in particular. A significant increase in assault-related cases was observed in a series of study by Lida et al. in Japan and Thorn et al. in Finland where they showed that causes of facial fractures in children in the early teens gradually assume a pattern similar to that of adults [3, 7, 11].

In this study the mandibular body and angle fracture consistently increased with age and occurred exclusively in males as in other studies [20]. Lida et al. explained these types of fractures as being one of the common fracture sites in adults and this may reflect the changes of etiology, such as an increase of assault, as well as the growth of the mandible in this age group [17].

Most of the mid-face fractures reported were in the older age groups and due to RTA or assault. Thoren et al. mentioned that fractures in the mid-face were frequently multiple and/or comminuted. Furthermore, they cannot be classified to any particular Le Fort classification [7]. The low incidence of mid-face fractures is due to the protruding anatomic position of the mandible and the cranium. This provides protection and absorbs most of the traumatic impact in addition to the fact that the mid-facial bones are more elastic [1, 24]. The proportion of pediatric patients identified with midfacial fractures increased in recent years, probably due to the increased use of adequate imaging. Van As et al. concluded that conventional radiographs were not exact for diagnosis of mid-facial fracture [7, 12].

The management of pediatric fractures at KDTH in this study reflects the tendency towards non-surgical procedures whenever possible except in severe multiple or comminuted fractures where surgical intervention is mandatory. That may be attributed to economic reasons where the cost leads patients and surgeons to choose less expensive treatment modalities. It also reflects the hot debate about surgical management of fractures in growing bones and its effect. Some authors advocates for conservative treatment of the growing bones whenever possible [20]. Others argue for the usefulness of open reduction and plate fixation in children and encourages removal of titanium plates after fracture healing [25]. Iatrou et al. stated that surgical treatment of fractures in adults has been established and documented, although more conservative treatment is still used in countries with poor resources. Closed reduction was selectively applied in condyle fractures [25].

The findings of this study have shown that the pediatric facial fractures in KTDH constitute 14.1 % of the total facial fractures. RTA and assault are the rising cause of pediatric fractures. Mandibular fractures are predominating, and in particular condylar fractures with all its morbidity.

Objective: To use finite element analysis (FEA) for evaluation of the biomechanics of plates used for the repair of mandibular fractures. Methods: Computerized tomography (CT) data for the normal human mandible were obtained from a patient's craniofacial region imaged in the axial plane at 1.5 mm intervals. These data were then imported into Mimics 7.3 (Materialise, Glen Burnie, MD, USA) in image format. Masks for cortical bone, cancellous bone and dentin were designated separately with tools available in Mimics. The masks for each entity were approximated by IGES curves and imported into ANSYS 8.0 (Ansys Inc., Canonsburg, PA, USA). The volumes created for these entities were meshed using tetrahedral shaped solid elements. Each entity was modeled as elastic and isotropic. Data for ultimate tensile strength, Poisson's ratio and Young's modulus for each entity were taken from information on the material properties of the mandible available in the literature. An artificial gap was created in the symphysis of the mandible to mimic a fracture. Plates were created and shaped to the contour of the mandible overlying the region of the fracture using Solid Works 2001 Plus (Solid Works Corporation, Concord, MA, USA). The plates were then exported in IGES format into the pre-existing model of the mandible in ANSYS. Four plate configurations were compared for fitness of use (Fig. 1): ladder; large/small band; small bands; and large band. Unicortical and bicortical screws were simulated as solid cylinders. The force of the unilateral molar clench used for FEA was 150 N (Fig. 2). Results: All bone-screw-plate constructs showed peak Von Mises stress surrounding the superior border of the screw proximal to the fracture on the side ipsilateral to the clench. Stresses did not exceed the ultimate stress for bone (120 MPa) in the region surrounding the screws on the anterior cortical surface. Stresses along the screw decayed towards the cancellous bone along the screw-bone interface. All configurations tested showed little or no stress in cancellous bone or lingual cortex. All configurations showed maximal tensile stress on the lower border of the mandible and maximal compression on the superior border. Conclusion: On the basis of FEA, we conclude that all plate configurations tested are suitable to repair mandibular fractures. Unicortical screw fixation is adequate for fixation. Time required for contouring and fixation along with other ancillary features should be the principal criteria in selection of specific types of plates for mandibular fracture reduction. 2351a5e196