Reliability of cranial flap fixation techniques: comparative experimental evaluation of suturing, titanium miniplates, and a new rivet-like titanium clamp (CranioFix): technical note.

Abstract

To ensure patients' safety, the mechanical strength of cranial flap refixation techniques and implants (sutures, titanium miniplates, and new rivet-like titanium clamps) had to be validated. With craniotomied cadaver skulls for each refixation technique, load-bearing tests were performed by applying an external force until an impression depth of the cranial flap of 2 mm was reached and the results were compared. CranioFix (Aesculap AG, Tuttlingen, Germany) and miniplates were revealed to be the strongest fixation devices, although with miniplates, the plastic deformation started from the beginning of load application, whereas CranioFix additionally provided a better spring-elastic reserve and a higher reproducibility of fixation strength not dependent on bone thickness and consistency. Flaps fixed by sutures were dislocated from the start. Although CranioFix offers distinct advantages over miniplates, both proved to be definitely superior to suturing, which is still used in many centers. Therefore, whether suturing can still be regarded as a state-of-the-art technique must be reconsidered.