Optimisation of osteosynthesis positioning in mandibular body fracture management using finite element analysis

Purpose: To investigate the applicability of finite element analysis (FEA) in Oral and Maxillofacial (OMF) surgery, by studying the effect of mandibular body height and osteosynthesis positioning on unilateral mandibular body fractures based on Champy’s technique. This proof of principle is a step towards developing a validated FEA simulation method that may be useful in the clinical setting for optimising mandibular fracture management. Methods: Mandibles made of polyurethane foam (Synbone ® ) , with heights of 18, 14, and 10 mm were used to create a FEA model with a unilateral straight-line fracture, fixated with a standard commercially available 6-hole 2 mm titanium miniplate (KLS Martin Group). Two different FEA programs were used for the comparison, namely: Solidworks and Comsol Multiphysics. The FEA outcomes were compared with a series of mechanical tests with polymeric models fixed in a customised device and loaded onto a mechanical test bench. Results: First, the study illustrated that the optimal plate position appeared to be the upper border. Second, lower mandibular height increases instability and requires a stronger osteosynthesis system. Conclusion: The FEA’s and polymeric model testing outcomes of unilateral non-comminuted fractures were highly comparable with current opinions of mandibular fracture management. FEA is an applicable tool in OMF surgery, as it can be used to predict the treatment outcome of mandibular fractures. The promising outcome of this study makes it worthwhile to do more extensive analysis in order to determine whether FEA alone is sufficient for optimisation of fracture management.