Angle Fractures

[tx oms]

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How are you treating angle fractures at your program? We've done everything from CR, Champy with MMF, Champy without MMF, trocar and 2 plates, and neck approach. I realize it depends on the situation, so how does your program treat a closed angle fracture and how do they treat an open fracture. Assume there's no other fracture.

We are generally opening every angle at this point, closed or open fracture, and either doing a Champy with MMF or using two plates via a trocar.

BTW, anyone using the strut plate?

 

[toofache32]

Ellis has an isolated-angle study going on right now comparing Champy without MMF, MMF only, and a 3rd method (which I can't remember because I haven't been on service forever). Basically, every 3rd poor bastard that comes in with an angle fx gets his mouth wired shut.

 

[esclavo]

How are you treating angle fractures at your program? We've done everything from CR, Champy with MMF, Champy without MMF, trocar and 2 plates, and neck approach. I realize it depends on the situation, so how does your program treat a closed angle fracture and how do they treat an open fracture. Assume there's no other fracture.

We are generally opening every angle at this point, closed or open fracture, and either doing a Champy with MMF or using two plates via a trocar.

BTW, anyone using the strut plate?

We are opening all angle fractures. I don't think I've seen but maybe two closed angle fractures... all the rest are open. Two attendings prefer treatment with 1.7 leibinger superior boarder plates and 3 weeks of IMF. The other likes a 2.0 superior boarder plate (monocortical screws) and 10-14 days of IMF (if the fractures are favorable). They are slowly reducing their time in IMF. I guess they don't truly think that the superior boarder plate alone is rigid, more semi rigid...outcomes have been extremely good. We do extra oral approach for comminution or lack of posterior occlusion. The Ellis article sounds interesting...

 

[toofache32]

Given a choice, Ellis will usually go with a single Champy plate only. No MMF. He gave a lecture a long time ago about outcomes which revealed his reasoning, but I can't remember any of it.

 

[Teefies]

We are opening all angle fractures. I don't think I've seen but maybe two closed angle fractures... all the rest are open. Two attendings prefer treatment with 1.7 leibinger superior boarder plates and 3 weeks of IMF. The other likes a 2.0 superior boarder plate (monocortical screws) and 10-14 days of IMF (if the fractures are favorable). They are slowly reducing their time in IMF. I guess they don't truly think that the superior boarder plate alone is rigid, more semi rigid...outcomes have been extremely good. We do extra oral approach for comminution or lack of posterior occlusion. The Ellis article sounds interesting...

I know I sound like a real a-hole, but I just can't help myself. It's "border". I know it doesn't take a spelling bee champion to make a great surgeon, but in all honesty, you really lose some credibility when you mispell such a simple word (multiple times). I know these may be harsh words, but let us all face the reality. When I read a doctor's record in which simple words are mispelled, the first thought that comes to my mind is "this person is a doctor?" I will try to be nicer in the future, I promise. Okay everyone, go ahead and pile on.

P.S. I actually did win the 3rd grade spelling bee and it was one of the greatest achievements of my life.

 

[esclavo]

I know I sound like a real a-hole, but I just can't help myself. It's "border". I know it doesn't take a spelling bee champion to make a great surgeon, but in all honesty, you really lose some credibility when you mispell such a simple word (multiple times). I know these may be harsh words, but let us all face the reality. When I read a doctor's record in which simple words are mispelled, the first thought that comes to my mind is "this person is a doctor?" I will try to be nicer in the future, I promise. Okay everyone, go ahead and pile on.

P.S. I actually did win the 3rd grade spelling bee and it was one of the greatest achievements of my life.

I stand corrected teefies it is border not boarder. I don't put the energy and effort into spelling when I write these posts. You can rest assured that if it is something that mattered, I'd put in a greater effort. I just type my little fingers at 80 words a minute when I am writing these posts and I don't go back and proof read. You can spell better than me. There was once a study that showed intelligence and ability to spell to be inversely related... if it really matters, I dictate it, have a secretary write it up for me, and then I proof read it with the dictionary. When I'm posting for you on SDN, I just type half-minded. If you are worried about if I am a doctor or not, just hang 48 hours with me and watch my mind and my hands at work and then you'll know what my profession is and if I am for real... 😉 I know you can spell but it doesn't mean that I'd refer to you for a procedure....but I'd hire you any day to edit my posts on SDN.

 

[toofache32]

I know I sound like a real a-hole, but I just can't help myself. It's "border". I know it doesn't take a spelling bee champion to make a great surgeon, but in all honesty, you really lose some credibility when you mispell such a simple word (multiple times). I know these may be harsh words, but let us all face the reality. When I read a doctor's record in which simple words are mispelled, the first thought that comes to my mind is "this person is a doctor?" I will try to be nicer in the future, I promise. Okay everyone, go ahead and pile on.

P.S. I actually did win the 3rd grade spelling bee and it was one of the greatest achievements of my life.

Take it easy on Esclavo...."border" has a special meaning for him.

 

[esclavo]

Take it easy on Esclavo...."border" has a special meaning for him.

alright, you beat me to it.... my hands just start to shake when I have to type that dang word and the pinky just slaps that "a" and I can't control it....

 

[Teefies]

I stand corrected teefies it is border not boarder. I don't put the energy and effort into spelling when I write these posts. You can rest assured that if it is something that mattered, I'd put in a greater effort. I just type my little fingers at 80 words a minute when I am writing these posts and I don't go back and proof read. You can spell better than me. There was once a study that showed intelligence and ability to spell to be inversely related... if it really matters, I dictate it, have a secretary write it up for me, and then I proof read it with the dictionary. When I'm posting for you on SDN, I just type half-minded. If you are worried about if I am a doctor or not, just hang 48 hours with me and watch my mind and my hands at work and then you'll know what my profession is and if I am for real... 😉 I know you can spell but it doesn't mean that I'd refer to you for a procedure....but I'd hire you any day to edit my posts on SDN.

You're right, it really doesn't matter to me or even the next guy whether you can spell or not. It probably doesn't even matter to the poor fool you just jacked up in the OR. However, it should matter to you. By reading your posts, it is quite obvious you are one that craves the respect of those around you. I think we all do to some degree. In other words, I'm just trying to help you out. Now let's talk more about paying me to edit your posts, I could really use some extra cash...

 

[esclavo]

... poor fool you just jacked up in the OR.

How did you know I just did my first craniotomy?

However, it should matter to you. By reading your posts, it is quite obvious you are one that craves the respect of those around you. I think we all do to some degree. In other words, I'm just trying to help you out. Now let's talk more about paying me to edit your posts, I could really use some extra cash...

I am sorry to hurt your feelings but spelling is about number.....43 on the top 50 things that matter to esclavo. Exception to this is when you are applying to a professional program or if you are a lawyer...

Teefies, I am just throwing you a bone and recognizing your power of spelling. Thank you for making that "unique" contribution to this forum. I am trying to acknowledge you and in turn reciprocate the "respect" that you say we are all craving. I have enough happy patients returned to full form and function out on the street, in my church, in my neighborhood, and in my family. I don't need your respect nor anyone elses on this forum. This forum is about information and sometimes entertainment. The anonymitiy of this forum makes it so we can avoid things like being "politically correct" and brown-nosing. Say what you want to say and let the merit of what you say stand on its own.

Now please contribute something more than what my junior high English teacher would if she was on this forum...I believe we were talking about angle fractures weren't we... thank goodness boards don't test spelling (I don't remember spelling being one of the eight areas of the specialty)... more data base and oral presentation skills on boards....this reply sounds like I'm irritated but I'm really not...I'll pay you a penny a mispelled word to go back and comb through my posts. I'm not only a poor speller but I'm cheap! But I am willing to pimp out your spelling prowess to the next pool of applicants. You can check the spelling on their applications and I'll collect the $$$$.

 

[tx oms]

You're right, it really doesn't matter to me or even the next guy whether you can spell or not. It probably doesn't even matter to the poor fool you just jacked up in the OR. However, it should matter to you. By reading your posts, it is quite obvious you are one that craves the respect of those around you. I think we all do to some degree. In other words, I'm just trying to help you out. Now let's talk more about paying me to edit your posts, I could really use some extra cash...

I wish you would get AIDS.

 

[TiggerJSA]

... thank goodness boards don't test spelling...

Don't you mean "bords"??

 

[TiggerJSA]

You're right, it really doesn't matter to me or even the next guy whether you can spell or not. It probably doesn't even matter to the poor fool you just jacked up in the OR. However, it should matter to you. By reading your posts, it is quite obvious you are one that craves the respect of those around you. I think we all do to some degree. In other words, I'm just trying to help you out. Now let's talk more about paying me to edit your posts, I could really use some extra cash...

Teefies, please say this out loud to yourself:

"I M We Todd Did, Sofa King, We Todd Did"

Then, try biting your own ear...

 

[Yah-E]

Teefies:

You should sea how I spale! Dude, I get yealed at all the time bye TX OMS! I extract da wrong tooth to bcuz I cant count. Your going too be my spaling tootor. Wear are you doing you're perio residancy?

 

[Yah-E]

I wish you would get AIDS.

Just out of middle of no where?! I love it!

 

[GatorDMD]

Teefies, please say this out loud to yourself:

"I M We Todd Did, Sofa King, We Todd Did"

Then, try biting your own ear...

 

[esclavo]

Don't you mean "bords"??

You're a genius Tigger! I was getting down on myself trying to figure out why in the world I spelled border "boarder"! Now with your insight, I guess I've got too much "boards" on the brain and I spelled it wrong. Either that or I am just board...errr there I go again, I mean bored. Tigger, you should be a psychologists like Ace Ventura...you could not only tell me when I spelled something wrong but why... Tiggers got a gift....I feel enlightened (for the second time this morning and I'm not even on the pot-which is where I receive most of my enlightening thoughts...)

 

[omfsStud]

You're right, it really doesn't matter to me or even the next guy whether you can spell or not. It probably doesn't even matter to the poor fool you just jacked up in the OR. However, it should matter to you. By reading your posts, it is quite obvious you are one that craves the respect of those around you. I think we all do to some degree. In other words, I'm just trying to help you out. Now let's talk more about paying me to edit your posts, I could really use some extra cash...

Don't worry, I think I saw your wife out making some extra cash the other day... 😱



[Image deleted]

 

[tx oms]

Don't worry, I think I saw your wife out making some extra cash the other day... 😱

That pic is the size of OMFSCardsFan's unit.

 

[OMFSCardsFan]

That pic is the size of OMFSCardsFan's unit.

And the whole time I thought you just had a deep throat...

 

[Dr. Pedo]

I know I sound like a real a-hole, but I just can't help myself. It's "border". I know it doesn't take a spelling bee champion to make a great surgeon, but in all honesty, you really lose some credibility when you mispell such a simple word (multiple times). I know these may be harsh words, but let us all face the reality. When I read a doctor's record in which simple words are mispelled, the first thought that comes to my mind is "this person is a doctor?" I will try to be nicer in the future, I promise. Okay everyone, go ahead and pile on.

P.S. I actually did win the 3rd grade spelling bee and it was one of the greatest achievements of my life.

Teefies-
I'm dumber having read your post! 😱 You really do sound like an a-hole especially when you can't SPELL the word MISSPELLED! You're an embarrassment--change your screen name and come back when you can spell and/or behave. 😉

 

[mtheman]

Come on guys take it easy on Teefies, his hormone therapy is making him PMS!

 

[rahmed]

I know I sound like a real a-hole, but I just can't help myself. It's "border". I know it doesn't take a spelling bee champion to make a great surgeon, but in all honesty, you really lose some credibility when you mispell such a simple word (multiple times). I know these may be harsh words, but let us all face the reality. When I read a doctor's record in which simple words are mispelled, the first thought that comes to my mind is "this person is a doctor?" I will try to be nicer in the future, I promise. Okay everyone, go ahead and pile on.

P.S. I actually did win the 3rd grade spelling bee and it was one of the greatest achievements of my life.

R u in a dental school, or about to start a program this summer/fall, or what is your relation to dentistry? Please let us know. and if you ar a pre-dent, or freshman/sophomore then keep away and don't mess up an important thread.

rahmed

 

[Teefies]

I wish you would get AIDS.

very original

 

[Teefies]

Teefies-
I'm dumber having read your post! 😱 You really do sound like an a-hole especially when you can't SPELL the word MISSPELLED! You're an embarrassment--change your screen name and come back when you can spell and/or behave. 😉

you're right, my bad

 

[Teefies]

R u in a dental school, or about to start a program this summer/fall, or what is your relation to dentistry? Please let us know. and if you ar a pre-dent, or freshman/sophomore then keep away and don't mess up an important thread.

rahmed

I'm actually a hygiene student

 

[adamlc18]

I'm actually a hygiene student

So how is the perio residency treating you?

 

[schrottypie]

So how is the perio residency treating you?

Perio residency is very gorueling - no jokey pokey. We have journal club 3x weekly and read much prestige journals J Periodontology. At other time we treat patients with respec and gingiva.

 

[OMFSCardsFan]

Perio residency is very gorueling - no jokey pokey. We have journal club 3x weekly and read much prestige journals J Periodontology. At other time we treat patients with respec and gingiva.

I've forgotten what it's like to have time to read...

 

[scalpel2008]

We use strut plates now and have been doing so for about a year. I think it is ridiculous to ORIF someone with rigid fixation and then keep them in MMF. Afterall, the one of the benefits of ORIF is to avoid MMF. It's sort of a "belts and suspenders" idea to do both. Some clinicians feel that it's necessary in a non compliant patient. we often go ahead and take our arch bars off at the end of the case.

 

[Doggie]

At other time we treat patients with respec and gingiva.

I'm just thinking out loud............when do you ever treat patients without gingiva?

 

[esclavo]

We use strut plates now and have been doing so for about a year. I think it is ridiculous to ORIF someone with rigid fixation and then keep them in MMF. Afterall, the one of the benefits of ORIF is to avoid MMF. It's sort of a "belts and suspenders" idea to do both. Some clinicians feel that it's necessary in a non compliant patient. we often go ahead and take our arch bars off at the end of the case.

What do you mean when you say "strut plates"? Are you doing extra oral or intra oral with trochar?

 

[scalpel2008]

What do you mean when you say "strut plates"? Are you doing extra oral or intra oral with trochar?

A strut plate is shaped like a ladder or railroad. Most mandible systems such as Styker, Synthes, Osteomed, etc. have them. It performs better than 2 separate plates by resisting rotational forces better. JOMS Feb 2005 has a decent study regarding it's utility in angle fractures. We typically do this intraorally using a trocar.

 

[Sprgrover]

I know I sound like a real a-hole, but I just can't help myself. It's "border". I know it doesn't take a spelling bee champion to make a great surgeon, but in all honesty, you really lose some credibility when you mispell such a simple word (multiple times). I know these may be harsh words, but let us all face the reality. When I read a doctor's record in which simple words are mispelled, the first thought that comes to my mind is "this person is a doctor?" I will try to be nicer in the future, I promise. Okay everyone, go ahead and pile on.

P.S. I actually did win the 3rd grade spelling bee and it was one of the greatest achievements of my life.

Civility is not only appreciated in these forums, it's a requirement. Play nice. Consider this a warning.

 

[esclavo]

A strut plate is shaped like a ladder or railroad. Most mandible systems such as Styker, Synthes, Osteomed, etc. have them. It performs better than 2 separate plates by resisting rotational forces better. JOMS Feb 2005 has a decent study regarding it's utility in angle fractures. We typically do this intraorally using a trocar.

Gotcha, thanks. I've used these plates just not on angles. I've put them on saw bones at the angle but not invivo...

 

[omfsres]

Gotcha, thanks. I've used these plates just not on angles. I've put them on saw bones at the angle but not invivo...

I love all the plates and techniques for available to us now, but I think it is important to remember that these injuries used to be treated with 25 cents worth of stainless steal wire. Here's how we treat angles:

Intern: MMF
Midlevel: sup. mini plate, inf mini locking recon plate
Chief: Champy with MMF 2 weeks
Private Practice: MMF

 

[scalpel2008]

I love all the plates and techniques for available to us now, but I think it is important to remember that these injuries used to be treated with 25 cents worth of stainless steal wire. Here's how we treat angles:

Intern: MMF
Midlevel: sup. mini plate, inf mini locking recon plate
Chief: Champy with MMF 2 weeks
Private Practice: MMF

interesting tx philosophy. so what do the interns and private practitioners do if you guys have a concomitant subcondylar fracture?

 

[OMFSCardsFan]

I love all the plates and techniques for available to us now, but I think it is important to remember that these injuries used to be treated with 25 cents worth of stainless steal wire. Here's how we treat angles:

Intern: MMF
Midlevel: sup. mini plate, inf mini locking recon plate
Chief: Champy with MMF 2 weeks
Private Practice: MMF

When was the last time our chief did a mandible? I looked at the books--not since before Christmas at least. I didn't feel like looking back any further.

 

[esclavo]

I love all the plates and techniques for available to us now, but I think it is important to remember that these injuries used to be treated with 25 cents worth of stainless steal wire. Here's how we treat angles:

Intern: MMF
Midlevel: sup. mini plate, inf mini locking recon plate
Chief: Champy with MMF 2 weeks
Private Practice: MMF

Isn't that interesting that we're going to end up where we started as interns.... how ironic. I guess we are all "interns at heart" 🙂