Cranial reconstruction with titanium clamps in frontal comminuted depressed skull fractures

摘要

OBJECTIVE: Frontal comminuted depressed skull fractures need special attention due to complications and aesthetics. The optimal method of reconstruction and fixation of frontal bone fragments remains a matter of discussion. We explored the advantages of reconstruction of frontal bone with titanium clamps. PATIENTS AND METHODS: From May 2007 to September 2011, we performed 18 craniotomies with titanium clamps to fix the cranial fragments. On the beginning of craniotomy, single-window craniotomy (n = 11) and 2-window craniotomy (n = 9) were designed. After dural closure and frontobasal reconstruction, these fragments were fixed with titanium clamps. A helical CT scan was obtained after operation and a 3-dimensional technique was performed to evaluate the postoperative results. RESULTS: The CranioFix titanium clamp system was applied in 18 patients. No intraoperative and postoperative complications related to clamps were observed. The number of bone fragments ranged from 2 to 5 (average 3.3 pieces) while the number of clamps ranged from 3 to 8 (average 5.8). The time of refixation ranged from 5 to 17 minutes with an average of 9.4 minutes. Obvious statistical significance (P = 0.015) was found in postoperative CT scan results between single-window group and 2-window group, although it is not statistically different in intraoperative subjective valuation (P > 0.05). In all 18 cases, the alignment of fragments was precise, the fixation rigid, and the aesthetic result satisfying. CONCLUSIONS: Reconstruction of the forehead by refixation of bone fragments with titanium clamps in frontal depressed skull fractures is safe and suitable. This technique promises to be a good alternative in the repair of frontal comminuted depressed skull fractures. The simplicity, reliable fixation, and fast handling are its prominent features.