Académique Documents
Professionnel Documents
Culture Documents
fractures in children
condylar fractures
CONTRA INDICATIONS
ESSIG’S WIRING
GILMER’S WIRING
RISDON’S WIRING
SUSPENSION WIRING
ESSIG’S WIRING
Now the wires are passed without looping to the other side of the
fracture line and 2 to 3 teeth away from the fracture line on the
opposite side.
Now this acts as an arch bar on which the other smaller wires are
tightened to stabilize the fracture.
GILMER’S WIRING
At least one firm teeth must be chosen anterior and posterior to the
fracture line.
Both the ends of the wire are brought out on the buccal side and
twisted.
The same procedure is carried out for all the chosen teeth in the
individual arches.
In this method second molars are usually chosen for anchorage on
either side.
Two base wires are grasped and twisted at mid line and adapted to
the necks of the teeth on the buccal side .
The Ivy loop embraces the two adjacent teeth.one or two Ivy eyelets
should be placed in each quadrant.
The two tail ends of the eyelet are passed through the interdental
space of the selected two teeth from buccal to lingual side.
One end of the wire is passed around the distal tooth lingually and
brought out from the distal interdental space over the buccal side and
threaded through the previously formed loop.
The other wire tail end is carried around the lingual surface of the
mesial tooth and brought out on the buccal surface from the mesial
interdental space, where it meets the first tail end wire.
The two wires are crossed and twisted together and the loop is
adjusted and bend towards gingiva.
Even when there is breakage of wire during fixation only that eyelet
can be removed and replaced.
HALLAM MODIFICATION ( 1945 )
WILLIAM MODIFICATION ( 1968 )
CLOVE HITCH METHOD
STOUT’S MULTI LOOP WIRING
The 20 cm long pre stretched wire is folded into two parts, one part
acts as the stationary wire and the other end is brought distal to the
second molar and taken around it on lingual side.
This working end is threaded through the mesial side of second
molar to the buccal side under the solder wire.
It is then looped around the stationary wire and solder wire and back
into the interdental space from buccal to lingual. The same procedure
is repeated for each tooth up to midline.
The solder wire is removed after the loops are formed and the loops
are twisted to form eyelets.
Finally the stationary and working ends of the wires are twisted
together.
ARCH BAR FIXATION
The arch bar is a flat, sturdy stainless steel bar on which fleats or
hooks are attached.
Of these the most commonly used are the pre fabricated Erich arch
bars.
CUSTOM MADE ACRYLATED ARCH BAR
The arch bar is measured to fit from first molar to first molar.
The arch bar is placed in such a way that the fleats or hooks face
towards the gingival margin.
This is continued for all the teeth and the arch bar is secured.
A 26 guage wire is thresded through the eye and the wire is withdrawn
with it the wire on the buccal surface.
OBWEGESER’S PROCEDURE
A 26 or 28 guage wire is inserted through the eye of the awl and the
awl is withdrawn till the lower border and directed upward along the
buccal surface of mandible to pierce through the buccal sulcus.
The two ends of the wire are adjusted and the splint is adjusted and
the lingual and buccal wires are held together and twisted in the region
of canine grooves, cut and finished inward.
SUSPENSION WIRING
FRONTAL SUSPENSION
It is used for fracture of maxilla at the Le Fort II or III level
A pre stretched 26 gauge SS wire is passed through this hole and bent
back so that an equal length protrudes on either side of this bur hole.
The two ends of wire are threaded through the eye of Rowe’s
zygomatic awl and crimped.
The awl is then passed downwards and forwards behind the frontal
process of the zygomatic bone deep to the zygomatic arch to pierce
through the oral mucosa in the upper buccal sulcus in the region of
upper molar teeth.
The wire ends are detached from the awl and secured nwith an
artery forceps while the awlm is withdrawn. These wire ends are to be
secured on arch bar.
The awl pierces the temporal fascia and passes medial to the
zygomatic bone and zygomatic buttress to pierce the buccal sulcus in
the region of first molar.
A pre stretched 26 gauge SS wire is then attached to the eye of the awl
and crimped.
The awl is withdrawn just above the zygomatic arch and reinserted
this time lateral to the zygomatic bone and directed downwards and
forwards to emerge through buccal sulcus. This makes wire loop
around zygomatic bone.
The wire ends are secured and adjusted so as they rest on zygomatic
bone.
The ends of the wire are then secured to the arch bar.
PIRIFORM APERTURE SUSPENSION
This can again be used for the fixation of a Lefort I fracture as the
piriform aperture is a stable bone present above the level of the
fracture level.
Wire is threaded through this hole and then attached to the arch bar.
ADVANTAGES OF CLOSED REDUCTION
DISADVANTAGES
Difficulty in speech
Social inconvinience