Fracture Mapping Redefines Feline Mandibular Angle Trauma—No Demographic Links Found

Characterization of Feline Mandibular Angle Fractures Utilizing In Silico Model Construction and Fracture Mapping

Tsung-Han Tu, Scott J. Hetzel, Jason W. Soukup

Background:
Feline mandibular angle fractures are anatomically complex and clinically challenging to repair due to the thin bone and irregular contours of the masseteric fossa. These fractures often require open reduction and internal fixation (ORIF), though implant design and placement are complicated by the region’s geometry. This study aimed to identify potential associations between fracture characteristics and patient demographics or trauma etiology, and to qualitatively evaluate fracture patterns using three-dimensional fracture mapping techniques.

Methods:
This retrospective study analyzed 22 mandibular angle fractures in 19 cats diagnosed via CT between 2008 and 2022. Fracture characteristics and demographics (age, sex, and trauma etiology) were recorded. In silico three-dimensional models were constructed for each fracture, and fracture lines were manually mapped onto a standardized mandibular template. Fracture patterns were then qualitatively analyzed across subgroups including simple versus comminuted fractures, bilateral fractures, trauma etiology, and juvenile versus adult cats. Fisher’s exact tests assessed associations between demographic or etiologic variables and fracture features.

Results:
No statistically significant associations were found between age, sex, or etiology and fracture type, location, displacement, or mandibular foramen involvement. However, fracture maps revealed two distinct patterns: (1) a common sigmoid-shaped fracture path from the ramus/body junction, through the mandibular foramen, to the area rostral to or at the angular process; and (2) a more chaotic pattern seen in comminuted fractures, with greater dorsal involvement and fewer following the artery sulcus. Most fractures (86%) were severely displaced. Half were comminuted, and more than half involved the mandibular foramen. Bilateral fractures followed symmetric but distinct paths. Fractures in younger cats were more likely to involve the foramen, possibly reflecting age-related structural differences.

Limitations:
The study was limited by small sample size and retrospective design. Many trauma etiologies were unknown, and the direction or force of impact could not be determined. Fracture origin and propagation were inferred rather than directly observed. Generalizability may be limited due to the referral hospital setting.

Conclusions:
No demographic or etiologic predictors of fracture pattern were identified. However, fracture mapping provided valuable insights into common trajectories, particularly highlighting a recurring sigmoid pattern through the mandibular foramen. These findings support the use of advanced imaging and modeling in treatment planning and suggest that mandibular geometry plays a key role in fracture propagation. Future biomechanical studies are recommended to guide implant design and improve surgical outcomes.

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