Should wiring be replaced by miniplating of mandibular fractures even in poor developing countries?

Abstract

Background:Management of mandibular fractures has evolved significantly over the past few decades from intraosseous wiring, compression plates to miniplates. Our department started using titanium miniplates and we conducted this study to evaluate its feasibility and compare it with wire osteosynthesis.

Methods: This is a prospective randomized study conducted on 150 cases of faciomaxillary trauma due to varied etiology with mandibular fractures; 75 cases each in the wire osteosynthesis group and titanium miniplating groups respectively. The two groups were compared in terms of the postoperative complications, hospital stay, cost of hardware used and patient satisfaction.

Results:Duration of surgery for the fixation of mandibular fractures was significantly reduced in the plating group as compared to the wiring group (2.0±0.4 versus 2.8±0.7 hours). Postoperatively, wound infection was observed in 4% of cases in the plating group and 16% in the wiring group, mal-occlusion was seen in 8% of patients, all in intra-osseous wiring group. Mal-union was seen in 6 of the wiring group patients and none in the plating group. Non-union was seen in 3 patients of the wiring group and none of the plating group patients. Patient acceptability and compliance was significantly better in the titanium miniplating group as compared to the Wiring group. Although plating is costly as compared to wiring, the overall advantages outnumber the wiring group.

Conclusions:Titanium miniplating is superior to wiring though comparatively costly but cost alone shouldn’t be the consideration in choosing a treatment option even in poor developing countries.