Abstract
Introduction
The decision between load-sharing (LS) and load-bearing (LB) osteosynthesis is determined
by an interplay of fracture-related and patient-related factors. In some situations,
a similar fracture in two different patients may be successfully treated by either
of these osteosynthesis methods. Our aim was to identify pre-operative patient-related
factors that may assist in deciding which form of osteosynthesis is employed.
Method
All adult patients who underwent open reduction and internal fixation of their mandible
fractures (excluding condyle) between 01 October 2018 and 01 June 2021 were retrospectively
identified. The odds of developing post-operative complications and requiring a return
to theatre (RTT) were calculated for each method of fixation and the following patient
factors: smoking, excess alcohol, substance misuse and severe mental health issues.
Results
Of 337 fractures treated using LS principles, 27/337 (8.0%) developed complications
of which 20/337 (5.9%) required RTT for repeat osteosynthesis. Of 74 fractures treated
using LB principles, 7/74 (9.5%) developed complications and 2/74 (2.7%) required
RTT for repeat osteosynthesis. The only patient factor that was found to have a statistically
significant increased odds of a complication requiring RTT was those fractures treated
with LS osteosynthesis who admitted drinking excess alcohol (OR=7.83, p=0.00, 95%CI=
3.13-19.60).
Conclusions
Complications when treating mandible fractures are rarely reported in the literature
and lack standardisation in their clinical significance. Figures generally represent
overall numbers of patients whereas individual fractures treated is more accurate.
In our study a complication occurred in 8% of treated fractures and 10% of patients.
The return to theatre rate was 7% of patients, comparing favourably with a recently
stated standard of 10% of patients as suggested by the Getting it Right First Time
(GIRFT) report.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to British Journal of Oral and Maxillofacial SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complications of Mandibular Fracture Repair and Secondary Reconstruction.Semin Plast Surg. 2020; 34: 225-231
Christensen B J, Mercante D E, Neary J, et al. Risk factors for severe complications of operative mandibular fractures. J Oral Maxillofac Surg. 2017;75(04):7870–7.87E10.
Morton M. Oral and Maxillofacial Surgery GIRFT Programme National Specialty Report. 2018. (Cited 22 Aug 21). Available from https://gettingitrightfirsttime.co.uk/wp-content/uploads/2020/05/OMFS-Report-May20K.pdf
- Determinants of surgical decisions about mandible fractures.J Oral Maxillofac Surg. 2003 Jul; 61: 808-813
- A retrospective comparative study of mandibular fracture treatment with internal fixation using reconstruction plate versus miniplates.J Craniomaxillofac Surg. 2019 Aug; 47: 1175-1180
- Potentially modifiable patient factors in mandible fracture complications: a systematic review and meta-analysis.Br J Oral Maxillofac Surg. 2022 Apr; 60: 266-270
- The Comprehensive AOCMF Classification System: Mandible Fractures- Level 2 Tutorial.Craniomaxillofacial trauma & reconstruction. 2014; 7
- AO Surgery Reference.Cited. 22 Aug 2021.; (Available from)
- A study of 2 bone plating methods for fractures of the mandibular symphysis/body.J Oral Maxillofac Surg. 2011 Jul; 69: 1978-1987
- Complications of Mandible Fractures Related to Substance Abuse.J Oral Maxillofac Surg. 2008; 66: 2028-2034
- Effect of Smoking on the Healing of a Mandibular Condyle Fracture.Eplasty. 2021 Mar; 8 (Cited 22 Aug 2021. Available from): e3
- New national alcohol guidelines in the UK: public awareness, understanding and behavioural intentions.J Public Health (Oxf). 2018 Sep 1; 40: 549-556
- Relationship of substance abuse to complications with mandibular fractures.J Oral Maxillofac Surg. 1993 Jan; 51: 22-25
- Mandible Fracture Complications and Infection: The Influence of Demographics and Modifiable Factors.Plast Reconstr Surg. 2016 Aug; 138
- Outcomes of mandible fracture treatment at an academic tertiary hospital: a 5-year analysis.J Oral Maxillofac Surg. 2014 Mar; 72: 550-558
- Classifying the causes of morbidity and error following treatment of facial fractures.Br J Oral Maxillofac Surg. 2022 Apr; 60: 308-312
- Patient compliance and mandible fractures: a prospective study.Int J Oral Maxillofac Surg. 2019 Jun; 48: 759-768
- Return to normal diet following mandibular fractures - how long is long enough?.Br J Oral Maxillofac Surg. 2021 Nov; 59: 1050-1055
- Time to Open Repair of Mandibular Fractures and Associated Complications.Journal of Oral and Maxillofacial Surgery. 2022; 78
- Treatment Delay Impact on Open Reduction Internal Fixation of Mandibular Fractures: A Systematic Review.Plastic and Reconstructive Surgery. 2018; 6
Article info
Publication history
Accepted:
March 8,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.
