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
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Article info
Publication history
Accepted:
March 8,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
