CHOICE OF TREATMENT TACTICS FOR OPEN FRACTURE OF THE ANGLE OF THE LOWER JAW WITH THE PRESENCE OF A TOOTH IN THE FRACTURE CLEFT
DOI:
https://doi.org/10.35220/2078-8916-2022-46-4.9Keywords:
determination of mechanical parameters of the bone, fractures of the lower jaw, tooth in the fracture gap, diastasis of the bone wound, repositioning, immobilization of fragments of the lower jawAbstract
The aim – determine the hardness and elasticity of bone tissue and improve the effectiveness of treatment of patients with open fractures of the lower jaw with the presence of a tooth in the fracture gap. Materials and methods. Clinical examination methods (objective examination), X-ray examination methods (computed tomography). 60 patients were examined and treated. In the treatment, a device for determining the mechanical parameters of the bone #150086 dated 12/30/2021 was used. Surgical treatment took place for 6 months on the basis of KMKL No. 12, ShCLV No. 2 in Kyiv from 02.01.2022 to 08.01.2022. There were 40 men and 20 women among the patients of all groups. The age of the patients ranged from 18 to 60, group I. In 40 patients with a diagnosis: In 10 patients, a unilateral fracture of the angle of the lower jaw was detected (group I). 20 patients had a bilateral fracture of the angle of the lower jaw (group II). 10 patients had a double fracture of the lower jaw (group III). A positive symptom of direct and indirect stress in the fracture areas was noted in all 60 patients. Scientific novelty. Determination of the optimal area of the bone, for applying bone fixators using a device for determining the mechanical parameters of the bone No. 150086 dated 12.30.2021. Improving the efficiency of tooth fixation in the fracture gap. Conclusions. The basis of success is the achievement of maximum diastasis of the bone wound and alignment of fragments, which allows to make the bite as natural as possible in the future and to restore it. The strength of bone tissue remains highly variable, so if the tooth remains in the area of the mandibular fracture, it is used as a support and improves the fixation of the fragments, which in turn reduces the risk of oral fluid entering the wound and at the same time better consolidation of the fragments. Normally, the strength limit of the cortical layer of the lower jaw in compression is 120–200 MPa, and in tension it is somewhat lower. The torsional strength of cortical bone is even lower, it is determined at the level of 90–100 MPa. Complications occurred in 4 patients with preserved teeth in the fracture line. Namely, 2 teeth (37,48), where the course of the fracture line passes through the hole of the tooth and 2 teeth (36,47), the fracture line passes obliquely through the hole of the tooth. The teeth were treated endodontically after trauma without rupture of the neurovascular bundle. One of the important factors remains the peculiarities of the biomechanical behavior of the fixator-bone system in this case determined by the presence of a contact zone of bone fragments, which makes it possible to directly perceive part of the load and, due to this, to unload the plate in the fracture area. After repositioning and immobilization of fragments of the lower jaw, it is necessary to create conditions for the processes of reparative osteogenesis.
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