“Comparison among 3 maxillomandibular fixation techniques for management of mandibular fractures – A prospective randomized study”

Abstract

Background

The Erich arch bar has been a traditional method for maxillomandibular fixation (MMF) in the closed management of mandibular fractures, but it presents significant disadvantages, including prolonged placement time, increased risk of operator injury, and compromised oral hygiene. To address these challenges, alternative methods such as IMF screws and hybrid arch bars have been introduced.

Purpose

This study aimed to compare the efficacy, advantages, disadvantages, and potential complications of three MMF techniques, IMF screws, hybrid arch bars, and Erich arch bars in the management of mandibular fractures.

Study design

This study follows the CONSORT guidelines for randomized clinical trials. A total of 45 patients with mandibular fractures were randomized into three equal groups: Group A (IMF screws), Group B (Hybrid arch bars), and Group C (Erich arch bars). Randomization was performed using a computer-generated sequence, with allocation concealment achieved through sealed opaque envelopes. Blinding was not feasible due to the nature of the interventions.

The primary outcome variables included occlusal assessment and fracture reduction. Secondary outcomes included the time required for placement and removal of MMF devices, postoperative pain (VAS score), and operator-related complications such as glove perforation.

Co-variates-Age, site of mandible fracture & multiple fracture of mandible.

Results

All 45 patients were included in the final analysis. Occlusion was successfully achieved in all patients except one (6.7 %) in the IMF screw group. The mean time for MMF placement and removal was highest in the Erich arch bar group, followed by the hybrid arch bar group, and was lowest in the IMF screw group (p < 0.001). Glove perforation occurred in 6 Erich arch bar group subjects during placement. The mean VAS pain score was highest in the Erich arch bar group at the time of placement, at 24 h, and at 1 week (p = 0.002, 0.004, and 0.018, respectively).

Conclusion

and Relevance: This study highlights that IMF screws offer a more efficient, safer, and less painful alternative for MMF compared to Erich and hybrid arch bars. Considering the shorter procedural time, reduced operator risk, and better patient comfort, IMF screws appear to be the preferred choice for the closed management of minimally to moderately displaced isolated mandibular fractures.