A study of fractured cranial flap refixation

Summary Objective To study the techniques of fractured cranial flap refixation (suture, wire and titanium clamps). Methods Twenty-four cadaver craniotomy flaps, sawn as fractured flap models, were divided into three groups, and every eight fractured flaps were reattached with sutures, wires and titanium clamps, respectively. Bone flap refixation was timed and measured for offset. For every fixation technique, load-bearing tests were performed on craniotomied skulls by applying an external force until the refixation system failed. The results were compared. Results The titanium clamp required significantly less time (142±16s) to fix than either suture (631±47s) or stainless steel wire (1104±48s). The titanium clamp also showed significantly smaller offset (average offset: 0.35±0.07mm) than either suture (average offset: 1.93±0.33mm) or stainless steel wire (average offset: 1.80±0.42mm). The titanium clamp (maximal force: 384.06±24.89N) was stronger than suture (maximal force 89.43±13.76N) and stainless steel wire (maximal force 285.51±10.46N). Conclusion The titanium clamp is a reasonable alternative method of fractured cranial flap refixation with respect to ease of use, time consumption, accuracy and strength.