Complications after osteosynthesis of craniofacial fractures—an analysis from the years 2015–2017

Bicsák, Ákos; Abel, Dietmar; Tack, Laurence; Smponias, Velissarios; Haßfeld, Stefan; Bonitz, Lars

doi:10.1007/s10006-020-00903-1

Cited by 8 publications

(8 citation statements)

References 33 publications

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“…The complication rate in our study is thus significantly below the internationally published average, which is given as up to 17%. [ 2 5 7 14 ] Besides, the number is significantly lower than for isolated mandibular fractures (8.17%). However, it is significantly higher than that of mid-face fractures (1.15%) because the complication rate includes both reduction errors, infections, patient noncompliance, and failure of the osteosynthesis material.…”

Section: Discussionmentioning

confidence: 95%

“…[ 1 2 3 ] This force often causes other injuries, such as traumatic brain injuries, eye injuries, or traumatization of other parts of the body, e.g., thorax, abdomen, or extremities. [ 2 4 5 ] According to the literature, men are more often affected, and the male-to-female ratio is about 2:1–8.9:1. [ 3 6 7 8 9 ] Young men are most often affected.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of panfacial fractures in a german supraregional trauma center between 2015 and 2017 – A retrospective study

Bicsák¹,

Abel²,

Wruck³

et al. 2021

Ann Maxillofac Surg

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Introduction: Panfacial fractures represent the most severe injuries to the face. The combination of these fractures determines the treatment strategy. This study aims to retrospectively review the data of adult patients treated for complex facial skull fractures in a hospital in Dortmund, Germany from 2015-2017. Materials and Methods: We extracted related patient data from the hospital electronic repository and reviewed the patient files and radiological images. The fractures were classified based on the AO-Classification. The statistical analysis was performed by descriptive statistical methods. The main goal was to determine the most common fracture combinations. Results: A total of 188 patients with panfacial fractures were identified (181 adults, 7 children and adolescents). The gender and age distribution corresponded to the international literature (male-to-female ratio: 3.1:1, most common injuries among young men). 2–9 fracture sites were identified per patient, resulting in a fracture frequency of 3.13 per patient. 69 different fracture combinations have been identified. The most common ones were combinations of lateral and central mid-face fractures, and combinations of nasal bone fractures with lateral midface fractures or nasal bone fractures combined with mandibular fractures. Between 1 and 13 osteosynthesis implants per patient were used for osteosynthesis; the most commonly used plates were 2.0 mm and 1.5 mm straight plates. The average inpatient stay was 3 days (standard deviation [SD] = 3.0 days), and the average operation time (incision to suture) was 39.5 min (SD = 53.5 min). Discussion: Panfacial fractures are the most complex maxillofacial injuries. The complication rate in this study (4.5%) is below the international data. The treatment of panfacial fractures requires designated centers with experienced teams and good interdisciplinary cooperation.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Evaluation of panfacial fractures in a german supraregional trauma center between 2015 and 2017 – A retrospective study

Bicsák¹,

Abel²,

Wruck³

et al. 2021

Ann Maxillofac Surg

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Patient safety, treatment outcome and economic factors have become of increasing importance during these decades 16 , 19 – 22 . The complication rates after facial bone fractures are reported between 4.67 and 17% 22 . These have a negative impact on the length of hospital stay, operations in cases with complications generally take longer and patients are longer disabled and need much rehabilitation efforts to be able to return to normal life activites 22 .…”

Section: Introductionmentioning

confidence: 99%

“…The complication rates after facial bone fractures are reported between 4.67 and 17% 22 . These have a negative impact on the length of hospital stay, operations in cases with complications generally take longer and patients are longer disabled and need much rehabilitation efforts to be able to return to normal life activites 22 . The removal of the osteosynthesis implants is a matter of discussion 23 , however, if a removal is indicated or requested by the patient, the best time to avoid implant osteointegration is 4–6 months time after surgery 22 .…”

Section: Introductionmentioning

confidence: 99%

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Long-term evaluation of treatment protocols for isolated midfacial fractures in a German nation-wide craniomaxillofacial trauma center 2007–2017

Bonitz

Wruck

Peretti

et al. 2021

Sci Rep

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An update on the trends in maxillofacial traumatology provides additional information on the actual and changing needs. This retrospective study aimed to review all patient records of patients treated for isolated midface fractures in the Department of Cranial- and Maxillofacial Surgery at the Dortmund General Hospital between 2007 and 2017. The patient radiographs and patient files were reviewed. The safety and efficacy of the applied methods were controlled by assessing complications based on the Clavien-Dindo classification system. The statistical analysis included descriptive methods including regression analysis and χ2-test. In eleven years, 3474 isolated midface fracture sites have been identified in 2868 patients. The yearly trend is slightly increasing, in elderly clearly worsening, in children and youth decreasing. The male-to-female ratio was 2.16:1 for the whole study population, in the age group 18–25 y.o. 6.95:1 while in elderly above 80 y.o. 1:2.51, the age group specific incidence reflects this result, too. The most common fractures were nasal bone fractures (1405), zygomatic fractures (832) and orbital floor fractures (700). The average hospital stay was 2.7 days, the most fractures were operated within 24 h. The complication rate was 2.02% (Clavien-Dindo class II–V). The incidence of midfacial fractures is increasing in the total population and especially in elderly, but decreasing in children. Development of injury prevention measures is needed in this population. The diagnostic and therapeutic procedures are appropriate, as there is a low complication rate and short inpatient stay observed.

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Osteosynthesis-associated infection in maxillofacial surgery by bacterial biofilms: a retrospective cohort study of 11 years

Zirk,

Markewitsch,

Peters

et al. 2023

Clin Oral Invest

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Objectives The aim of this retrospective cohort study was to determine risk factors for osteosynthesis-associated infections (OAI) with subsequent necessity of implant removal in oral and maxillofacial surgery. Materials and methods A total of 3937 records of patients who received either orthognathic, trauma, or reconstructive jaw surgery from 2009 to 2021 were screened for osteosynthetic material removal due to infection. Treatment-intervals, volume of applied osteosynthetic material, and respective surgical procedures were also assessed. Moreover, intraoperatively harvested microbial flora was cultured and subsequently identified by MALDI TOF. Bacteria were then screened for antibiotic resistance via VITEK system or, if necessary, via agar diffusion or epsilometer test. Data was analyzed utilizing SPSS statistical software. For statistical analysis of categorical variables, chi-square tests or Fisher exact tests were used. Continuous variables were compared via non-parametric tests. The level of significance for p-values was set at < 0.05. Descriptive analysis was also performed. Results The lower jaw was more prone to OAI than the mid face region. Larger volumes of osteosynthetic material led to significantly more OAI, resulting in reconstruction plates bearing the highest risk for OAI especially when compared to small-volume mini-plates frequently applied in trauma surgery. Among OAI associated with implant volumes smaller than 1500 mm3, the detection of Streptococcus spp., Prevotella spp., Staphylococcus spp., and Veillonella spp. was significantly elevated, whereas implant volumes larger than 1500 mm3 showed a significant increase of Enterococcus faecalis, Proteus mirabilis and Pseudomonas aeruginosa. High susceptibility rates (87.7–95.7%) were documented for 2nd- and 3rd-generation cephalosporines and piperacillin/tazobactam. Conclusion High material load and lower jaw reconstruction bear the greatest risks for OAI. When working with large volume osteosynthetic implants, gram-negative pathogens must be considered when choosing an appropriate antibiotic regime. Suitable antibiotics include, e.g., piperacillin/tazobactam and 3rd-generation cephalosporines. Clinical relevance Osteosynthetic material utilized in reconstructive procedures of the lower jaw may be colonized with drug-resistant biofilms.

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Complications after osteosynthesis of craniofacial fractures—an analysis from the years 2015–2017

Cited by 8 publications

References 33 publications

Evaluation of panfacial fractures in a german supraregional trauma center between 2015 and 2017 – A retrospective study

Evaluation of panfacial fractures in a german supraregional trauma center between 2015 and 2017 – A retrospective study

Long-term evaluation of treatment protocols for isolated midfacial fractures in a German nation-wide craniomaxillofacial trauma center 2007–2017

Osteosynthesis-associated infection in maxillofacial surgery by bacterial biofilms: a retrospective cohort study of 11 years

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