Unexpected plate fracture in a three-dimensional subcondylar locking plate system

Abstract

Fractures of the mandibular condyle still account for a significant proportion of all mandibular fractures, and open reduction and internal rigid fixation of subcondylar fractures has become the standard treatment for this condition. The preference for this approach rests on the considerable technical progress made in this domain, especially in hardware development (e.g., three-dimensional anatomically specifically shaped and biomechanically stable locking subcondylar plate systems), as well as on an improved understanding of the osteobiology and osteophysiology of fracture healing. However, in the present case, the postoperative complication of unexpected fatigue plate fracture in a 68-year-old male patient after open treatment of a subcondylar fracture of the mandible could not be averted despite application of a mechanically stiff enough locking plate and anatomically accurate fracture reduction. This unusual case highlights the need for further osteophysio-biological research and for possible modification of the hardware system in view of the biomechanically complex nature of mandibular subcondylar fracture surgical treatment.