{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:53:55Z","timestamp":1760144035002,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: The lack of resources limits the treatment of craniomaxillofacial fractures (CMF) in low-income countries (LIC). Therefore, Barton bandages and\/or interdental wiring are considered in these regions. Fracture reduction is maintained by permanent occlusion for 6 weeks, which often leads to limited compliance and dissatisfying results. The aim of this cadaver-based study is to evaluate the feasibility of the use of an external face fixator (EFF) for the treatment of CMF, its biomechanical values and to define the optimal pin insertion points and angles. Materials and Methods: An AO hand fixator was used. CMF of types Le Fort 1\u20133 with split fractures of the hard palate were treated with EFF on 13 anatomical specimens. Fractures were created using a chisel, and pins were placed in specific anatomical regions. The maximal pull-out force [N] of pins was analysed by a tensile force gauge, and Fmax of the mandibular pins was evaluated. Computer tomography scans were performed on the healthy, fractured and EFF-treated skulls. Results: The pull-out forces for the single pins were mandibular pins (n = 15, median 488.0 N), supraorbital pins (n = 15, median 455.0 N), zygomatic pins (n = 14, median 269.1 N), medial hard palate pins (n = 12, median 208.4 N) and lateral hard palate pins (n = 8, median 49.6 N). Conclusions: The results indicate that the operation technique is feasible, and the stability of the EFF is sufficient for maintaining the reduction. The required pins can safely be inserted into the described areas with good reduction results. Using EFF offers a feasible alternative to the non-surgical treatment of CMF in LIC.<\/jats:p>","DOI":"10.3390\/bioengineering11030279","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T09:32:30Z","timestamp":1710495150000},"page":"279","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Off-Label Use of an External Hand Fixator for Craniomaxillofacial Fractures\u2014An Anatomical Feasibility Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Florian","family":"Wichlas","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital Salzburg, Paracelsus Medical University, M\u00fcllner Hauptstrasse 48, 5020 Salzburg, Austria"},{"name":"No Limit Surgery, Ernest-Thun-Strasse 6, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1610-9644","authenticated-orcid":false,"given":"Marco","family":"Necchi","sequence":"additional","affiliation":[{"name":"No Limit Surgery, Ernest-Thun-Strasse 6, 5020 Salzburg, Austria"},{"name":"Department of Surgery and Orthopaedics, Hospital Sterzing, Margarethenstra\u00dfe 24, 39049 Sterzing, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Gruber","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital Salzburg, Paracelsus Medical University, M\u00fcllner Hauptstrasse 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6900-9757","authenticated-orcid":false,"given":"Valeska","family":"Hofmann","sequence":"additional","affiliation":[{"name":"No Limit Surgery, Ernest-Thun-Strasse 6, 5020 Salzburg, Austria"},{"name":"BG Trauma Centre, Department of Trauma and Reconstructive Surgery, University of T\u00fcbingen, 72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3541-6973","authenticated-orcid":false,"given":"Susanne","family":"Deininger","sequence":"additional","affiliation":[{"name":"No Limit Surgery, Ernest-Thun-Strasse 6, 5020 Salzburg, Austria"},{"name":"Department of Urology and Andrology, University Hospital Salzburg, Paracelsus Medical University, M\u00fcllner Hauptstrasse 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian Hubertus Markus","family":"Deininger","sequence":"additional","affiliation":[{"name":"No Limit Surgery, Ernest-Thun-Strasse 6, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8352-7371","authenticated-orcid":false,"given":"Amelie","family":"Deluca","sequence":"additional","affiliation":[{"name":"Institute of Tendon and Bone Regeneration, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Steidle-Kloc","sequence":"additional","affiliation":[{"name":"Institute of Anatomy and Cell Biology|Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Center of Anatomy and Cell Biology, Salzburg and Nuremberg, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Pruszak","sequence":"additional","affiliation":[{"name":"Institute of Anatomy and Cell Biology|Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Center of Anatomy and Cell Biology, Salzburg and Nuremberg, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rn","family":"Wittig","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Salzburg, Paracelsus Medical University, M\u00fcllner Hauptstrasse 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Deininger","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital Salzburg, Paracelsus Medical University, M\u00fcllner Hauptstrasse 48, 5020 Salzburg, Austria"},{"name":"No Limit Surgery, Ernest-Thun-Strasse 6, 5020 Salzburg, Austria"},{"name":"Institute of Tendon and Bone Regeneration, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4103\/2006-8808.128723","article-title":"Facial fracture management in Northwest Nigeria","volume":"5","author":"Taiwo","year":"2013","journal-title":"J. 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