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Use of Herbert Cannulated Bone Screw in the Treatment of Mandibular Fractures

The prime aim of managing the mandible fractures must be the patient’s return to the previous level of functions and aesthetics. There is no doubt that maxillofacial trauma management has been very demanding for maxillofacial … Read More

Herbert screw

The prime aim of managing the mandible fractures must be the patient’s return to the previous level of functions and aesthetics. There is no doubt that maxillofacial trauma management has been very demanding for maxillofacial surgeons. Moreover, many clinical and biomechanical studies are being conducted aiming for the improvisation of established techniques and materials. These different approaches include closed reduction with maxillomandibular fixation, open reduction through wire osteosynthesis, open reduction through rigid or functionally stabilized internal fixation. In the late 1950s, the Association for the Study of Internal Fixation (ASIF) was formed to discuss the internal fixation of fractures. All forces should be counterbalanced by the rigid internal fixation evolved while functional loading of the mandible that allows three-dimensional stability across the fracture line which reduces the subjected strain and facilitates primary healing of the bone. 

In 1970, Brons and Boering introduced traction osteosynthesis for the maxillofacial area which was a rigid fixation technique for managing the mandibular fracture. The fractured segments were immobilized together with producing continuous compression along the fracture line. Traction osteosynthesis systems proved effective in providing maximum rigidity as compared to all other fixation techniques mainly in oblique fractures. In 1984, a new technique was introduced by Herbert and Fisher for the management of scaphoid bone fracture which proved an effective means for providing rigid internal fixation of fracture segments in different areas of orthopedic surgery, particularly in the case of small bones. Whereas the recorded current literature indicates the dominance of Herbert screw in the treatment of orthopedic fractures. However, no sufficient data is available regarding the possible results of Herbert bone screw fixation in maxillofacial trauma. Subsequently, a study was conducted to assess its outcome in the case of mandibular fractures.

Material and procedure

In a prospective clinical and radiographic study performed on eleven patients with a mandibular fracture who were selected from the Emergency Ward of Alexandria University Teaching Hospital from November 2016 to June 2017. All the selected patients were adults with no gender preference and suffering from recent, non-comminuted, uninfected, unfavorable fracture where open reduction and internal fixation of mandibular fracture was required. In these cases, symphysis, para symphysis, body, and angle were included but systemic diseases that could have intervened with healing were excluded. Informed consent was received from all the patients before starting the surgical procedure for the management of the fracture with open reduction and direct internal osteosynthesis. To apply the Herbert bone screw, the traction osteosynthesis principle was used.

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