During the last decade, rigid internal fixation with miniplates and screws has gained widespread acceptance in the correction of both congenital and acquired craniomaxillofacial deformities. Recent studies have proposed that the currently employed metallic plates and screws may require removal because of potential facial growth restriction in growing children. Others have reported bone resorption under the plate due to stress shielding, infection, extrusion, and palpability in regions where there is minimal tissue coverage. Because these implants are radiopaque, they generate significant artifacts that interfere with radiological studies and with radiation therapy in patients undergoing treatment for malignancies. There is no question that the use of a biodegradable plating system would eliminate each of these potential or real problems, because stability is necessary only for a reasonably short period until the fracture segments have become united.
We report the initial phase of a long-term study examining various materials that will be available for fabrication of a biodegradable plate and screw system. We evaluated a commercially developed biodegradable plate and screw system to treat zygomatic arch fractures in a rabbit model. Fractures were surgically created at the midpoint of each zygomatic arch. The experimental animals were then divided into three equal groups. Fractures in the first group were permitted to heal without any form of stabilization. In the second group, segments were secured with standard titanium plates and screws. Biodegradable plates and screws were employed for stabilization in the experimental group. Animals were then killed, and radiographs were obtained at 2, 4, 6, and 8 weeks. Zygomatic complexes were removed en bloc, and routine hematoxylin and eosin slides were obtained for light microscopy. Without fixation, fracture segments became significantly displaced. Findings were almost identical in the two treatment groups. This biodegradable system appears to have promise in the care of patients with maxillofacial trauma of the midface.
© 1992 Mutaz B. Habal, MD