📖 Oral and Maxillofacial Surgery

Champy Technique of Fracture Stabilization

The Champy technique, developed by Champy et al. in the mid-1970s, is a method of fracture stabilization that utilizes non-compression monocortical miniplates applied as tension bands. This technique is particularly relevant in the context of mandibular fractures and is based on biomechanical principles that optimize the stability and healing of the bone.

Key Principles of the Champy Technique

1. Biomechanical Considerations:

   • Tensile and Compressive Stresses: Biomechanical studies have shown that tensile stresses occur in the upper border of the mandible, while compressive stresses are found in the lower border. This understanding is crucial for the placement of plates.
   • Bending and Torsional Forces: The forces acting on the mandible primarily produce bending movements. In the symphysis and parasymphysis regions, torsional forces are more significant than bending moments.

2. Ideal Osteosynthesis Line:

   • Champy et al. established the "ideal osteosynthesis line" at the base of the alveolar process. This line is critical for the effective placement of plates to ensure stability during the healing process.
   • Plate Placement:
     • Anterior Region: In the area between the mental foramina, a subapical plate is placed, and an additional plate is positioned near the lower border of the mandible to counteract torsional forces.
     • Posterior Region: Behind the mental foramen, the plate is applied just below the dental roots and above the inferior alveolar nerve.
     • Angle of Mandible: The plate is placed on the broad surface of the external oblique ridge.

3. Tension Band Principle:

   • The use of miniplates as tension bands allows for the distribution of forces across the fracture site, enhancing stability and promoting healing.

Treatment Steps

1. Reduction:

   • The first step in fracture treatment is the accurate reduction of the fracture fragments to restore normal anatomy.

2. Stabilization:

   • Following reduction, stabilization is achieved using the Champy technique, which involves the application of miniplates in accordance with the biomechanical principles outlined above.

3. Maxillomandibular Fixation (MMF):

   • MMF is often used as a standard method for both reduction and stabilization, particularly in cases where additional support is needed.

4. External Fixation:

   • In cases of atrophic edentulous mandibular fractures, extensive soft tissue injuries, severe communication, or infected fractures, external fixation may be considered.

Classification of Internal Fixation Techniques

• Absolute Stability:

  • Rigid internal fixation methods, such as compression plates, lag screws, and the tension band principle, fall under this category. These techniques provide strong stabilization but may compromise blood supply to the bone.

• Relative Stability:

  • Techniques such as bridging, biologic (flexible) fixation, and the Champy technique are classified as relative stability methods. These techniques allow for some movement at the fracture site, which can promote healing by maintaining blood supply to the cortical bone.

Biologic Fixation

• New Paradigm:
  • Biologic fixation represents a shift in fracture treatment philosophy, emphasizing that absolute stability is not always beneficial. Allowing for some movement at the fracture site can enhance blood supply and promote healing.
• Improved Blood Supply:
  • Not pressing the plate against the bone helps maintain blood supply to the cortical bone and prevents the formation of early temporary porosity, which can be detrimental to healing.

• Mid – face distraction: Not performed until 3.5 years to ensure adequate bone stock.
• Distraction osteogenesis principle: Stress – tension principle.
• Zero latency period: Followed in children due to high osteogenic potential.
• Distraction histiogenesis: Simultaneous lengthening of soft tissue envelope with bone.
• Consolidation phase: 6 – 8 weeks (twice the time of initial distraction).
• Inverted L osteotomy: For advancements > 12 mm with counterclockwise rotation.
• BSSO limitation: Transverse movements are least possible.