Evaluating the Effect of Minimizing Screws on Stabilization of Symphysis Mandibular Fracture by 3D Finite Element Analysis.

PURPOSE: The objective of this work is to integrate structural optimization and reliability concepts into mini-plate fixation strategy used in symphysis mandibular fractures. The structural reliability levels are next estimated when considering a single failure mode and multiple failure modes. PATIENTS AND METHODS: A 3-dimensional finite element model is developed in order to evaluate the ability of reducing the negative effect due to the stabilization of the fracture. Topology optimization process is considered in the conceptual design stage to predict possible fixation layouts. In the detailed design stage, suitable mini-plates are selected taking into account the resulting topology and different anatomical considerations. Several muscle forces are considered in order to obtain realistic predictions. Since some muscles can be cut or harmed during the surgery and cannot operate at its maximum capacity, there is a strong motivation to introduce the loading uncertainties in order to obtain reliable designs. The structural reliability is carried out for a single failure mode and multiple failure modes.
RESULTS: The different results are validated with a clinical case of a male patient with symphysis fracture. In this case while use of the upper plate fixation with four holes, only two screws were applied to protect adjacent vital structure. This behavior does not affect the stability of the fracture.
CONCLUSION: The proposed strategy to optimize bone plates leads to fewer complications and second surgeries, less patient discomfort, and shorter time of healing.