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. 2022 Sep;15(3):189-200.
doi: 10.1177/19433875211022573. Epub 2021 Jun 21.

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

Matthew E Pontell  1 , Eva B Niklinska  2 , Stephane A Braun  1 , Nolan Jaeger  3 , Kevin J Kelly  3 , Michael S Golinko  3
Affiliations

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

Matthew E Pontell et al. Craniomaxillofac Trauma Reconstr. 2022 Sep.

Abstract

Study design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes.

Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures.

Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center.

Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications.

Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.

Keywords: ORIF; absorbable; biodegradable; fracture; mandible; open reduction internal fixation; pediatric; resorbable; systematic review; titanium.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Trial flow diagram demonstrating the process by which patients were selected for systematic and institutional review.
Figure 2.
Figure 2.
Image depicts 2 separate analyses. On the left, complication rates for resorbable fixation are listed by fracture site, statistical analysis was then performed to determine if the use of resorbable hardware for ORIF of any of the fractures listed increased the risk of complications in the resorbable subgroup. The process was then repeated on the right side for the titanium subgroup. A separate analysis was then performed comparing the risk of complications between the titanium and resorbable subgroups by fracture site.
See this image and copyright information in PMC

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