Factors contributing to the surgical retreatment of mandibular fractures

Abstract

The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the "reoperated" group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.

Use of the locking 2.0-mm fixation system for treating mandibular fractures with the potential for complications

“…However, this study demonstrated that the use of 2.0-mm locking plates was efficient in the treatment of mandibular fractures in such patients. Alcohol and drug abuse have been reported as factors contributing to the occurrence of complications after the treatment of mandibular fractures [9] in special nonunion [5]. A previous study confirmed that alcohol abuse resulted in reduced osteoinduction [22].…”

“…However, there was a mean age 41.2 years, which is higher than the expected mean for mandibular fractures and may be associated with possible complications. Age is considered a contributing factor to the surgical retreatment of mandibular fractures [9]. An increase in age has been associated with the abnormal union of mandibular fractures, which is likely due to a decline in general health [7,8].…”

“…Additionally, smoking was reported for some of the cases. Smoking is considered a contributing factor to the development of postoperative complications [9,23]. It is known that smoking reduces vascularization, which is associated with a slower bone repair process [4].…”

“…Fracture exposure is reported as a contributing factor to the surgical retreatment of mandibular fractures [9]. An exposed fracture presents a great risk of infection, and more rigid systems are indicated in the treatment of such cases [10,12].…”

“…Although there is no consensus in the literature, factors including substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and time between trauma and treatment should be considered as those that contribute to the occurrence of such complications [5][6][7][8][9]. One way to overcome these described factors in the treatment of mandibular fractures is the use of more rigid systems [10][11][12], such as locking 2.4 mm plates.…”