Open reduction internal fixation (ORIF) is usually the method of choice for complete simple body fractures to avoid the drawbacks and inconveniences of MMF in the majority of patients.
It is recommended in all displaced fractures and noncompliant patients.
|Seldom indicated for non-mobile non-displaced fractures with undisturbed occlusion.|
- When fracture topography and muscular forces (favorable fracture) allow a stable environment of undisturbed healing
- Fully compliant individual who is willing to adhere to a non-chew diet and avoid physical exercise and sports for a period of 6 weeks
- Patient must be advised that additional treatment may be required if complications arise during the observation period.
|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, lag screws|
Advantages of the lag screws over plate fixations are:
- Rapid application with a high level of stability
- Ideal fracture alignment and interfragmentary buttressing
- Intraosseous location avoiding palpability
- Less fixation hardware resulting in lower cost
- Technically demanding
- Difficult implant removal (if needed)
Lag screws can hardly be used in transverse fractures of the body.
|ORIF, one miniplate|
|Simple fractures in compliant patients with good dentition and buttressing of the segments after reduction.|
|ORIF, two plates|
|Simple fractures in transitional areas of the mandibular body.|
|ORIF, one large plate|
|Reduced bone buttressing requiring load bearing fixation.|
- Delayed fracture treatment
- If more stability is required
|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|