Observations on the use of rigid fixation for craniofacial deformities in infants and young children

With the introduction of smaller plating systems, many surgeons have adopted their use for craniofacial procedures in infants and small children. We have encountered some previously undescribed problems associated with the use of plates and screws in infants and children. These problems can be classified into three general areas: 1) Plate displacement. This occurs after placement of the metal plates on the outside of the infant calvaria. With subsequent growth, these plates and screws may be found along the inner cortex of the skull with screw points embedded through dura. 2) Plate and screw isolation. In certain locations in young children, plates placed on the outer cortex of bone may later be found to be more prominent, isolated on a peninsula of bone. 3) Plate placement. We have also encountered plates that have been placed along the inner cortex of the skull during a previous operative procedure. This makes subsequent surgery extremely difficult and may increase the risk for secondary surgery. We propose that a previously described model for growth, involving areas of bony resorption and deposition, may be responsible for the observed plate displacement.