# Choice of Screws for Fixation of Mandibular Condyle Fractures Guided by Anthropometric Data
## 4 Discussion  
### Issues Related to the Surgical Treatment of the Condylar Process and Mandibular Head Fractures  
The treatment of both the condylar process and mandibular head fractures has been controversial for some time. Among the methods used, two basic treatment techniques can be distinguished: ORIF or conservative treatments of closed reduction, intermaximillary fixation, traction, physiotherapy, or even no treatment. Each of these types of treatment has its advantages and disadvantages: conservative treatment can lead to an open bite, malocclusion, chronic pain, or ankylosis, resulting in complete blockage of the joint [14; 15] if a dislocated fracture occurs.  
Currently, the standard ORIF of the condylar process is titanium alloys when resolvable polymer anastomoses have failed in terms of strength [16]. Metallic resorbable osteosynthesis is under consideration [10]. This may be an important alternative to non-resorbable titanium fixation in the future [17].  
Rigid fixation is considered the treatment of choice by many authors in fractures of the condylar process [18] and the mandibular head [2], ensuring the anatomical stability of the osteosynthesis [19], which is necessary to obtain the correct occlusion after the procedure [20], in addition to recovery and efficient mastication. Complications associated with abnormal union formation after fracture fixation are associated with infection, an atrophic mandible, inappropriate reduction, multiple fractures, repeated trauma, patient compliance, and, in particular, poor stability [21]. Fracture infections promote the activity of fibroblasts in relation to the activity of osteoblasts. This results in fibrous adhesions, which results in non-union [22] and mobility of pathological bone fragments.  
[PERSON] et al. compared the incidence of postoperative complications related to the stability of occlusion, and showed that edentulous patients or patients with unstable occlusion have a greater chance of developing complications after osteosynthesis performed with 2.0 and 2.4 mm fixation systems [23]. The influence of occlusion on the stability of the fixation osteosynthesis treatment was also demonstrated by [PERSON] et al. and [PERSON] et al., who assessed postoperative stability as a statistically significant component of the Mandible Injury Severity Score (MISS). They also included parameters such as fracture type, location, soft tissue involvement, infection, and displacement of the fracture. A higher MISS determines both the severity of the fracture in terms of fixation and the probability of complications [24; 25].  
Another factor that modifies stability is the shape of the plates. Small plates do not perform well mechanically [26]. However, among the many plate shapes available, it is possible to choose the most durable plate as a base for the condyle fracture [27] (which is a relatively easy fracture to treat) and for ORIF of the condylar neck [20; 28]. Due to limited space, ensuring proper fixation stability is a challenge, especially in the condylar neck top region [28]. The use of an appropriate fixation material in the form of two osteosynthetic plates for wide and low condylar processes (less than 10 mm) [29] or a dedicated plate for long and slender processes is crucial to ensure a long-lasting treatment effect [30]. The use of the correct screws is crucial in this case.  
When considering the issue of the length of screws fixing the plates, it should be noted that the longer the screws used, the stronger they anchor in the bone and stabilize the osteosynthesis [31; 32; 33]. The longer the screw, the more stable the fixation, even for plateless osteosynthesis [34; 35]. Thus, it is advisable to determine the thickest osteosynthesis-suitable bone regions in the mandible. Furthermore, higher screw diameters can be used in thicker bone sites [36], thus benefiting stabilization.