Open reduction internal fixation (ORIF) is usually the method of choice for simple symphyseal fractures in order to avoid the drawbacks and inconveniences of MMF in the majority of patients.
It is recommended in all unstable fractures and noncompliant patients.
Closed treatment of simple fractures is still well accepted as an alternative to open treatment.
|Closed treatment (MMF)|
|Non- or minimally displaced simple fractures in compliant patients with good dentition amenable to MMF.|
- Premorbid or unstable medical condition preventing general anesthetic
- Conditions making open reduction and internal fixation difficult
- Patient refusal of operative treatment
- Unavailability of plates and screws
Special consideration: MMF may be contraindicated in patients with psychiatric disorders, seizure disorders, and alcoholics.
|ORIF, two lag screw fixation|
|Oblique or sagittal fractures where two lag screws can be placed from the buccal or lingual cortices.|
- Rapid application with a high level of stability
- Perfect bony reduction after interfragmentary compression
- Lower cost compared to plate and screw fixation
- Intraosseous location avoiding palpability
- Technically demanding (only one chance to get it right)
- Difficult implant removal (if needed)
|ORIF, lag screw and plate|
|Oblique or sagittal fractures where only one lag screw is possible. The plate is used to supplement the fixation.|
This technique is a backup procedure for two lag screw procedure where only one lag screw could be inserted due to anatomical or technical reasons.
Note: these fractures could also be treated with two miniplates.
|ORIF, one plate and arch bar|
|Simple fractures when used in combination with a stable arch bar.|
- Anatomical and technical limitation for the placement of two plates
- easy to place and less expensive relative to two plates
|ORIF, two plates|
|Cases where an arch bar is not possible because of missing teeth, loose teeth, or the objection to using an arch bar, or distal trailing fractures not amenable to the other treatments.|
- Easy to contour and to secure to the mandible using monocortical screws
- Rapidly applied and provide stable fixation
- Readily available in most operating rooms
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|