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14-08-2011 | Orthopaedics | Article

Mandibular fracture severity flags risk for postop complications


Free abstract

MedWire News: The risk for postoperative inflammatory complications (POICs) after mandibular fracture surgery is related to the severity of the injury, US researchers have found.

Pre-existing conditions also increased the likelihood of the patient making a straightforward recovery, the team reports in the Journal of Oral and Maxillofacial Surgery.

Thomas Dodson (Massachusetts General Hospital, Boston) and co-workers examined medical records for 44 mandibular fracture patients who developed POICs between 2004 and 2010, and 88 patients who did not experience any complications.

The patients were aged an average of 30.5 years, 82% were male, and 64% of fractures occurred during an assault. Sixty per cent of patients had a history of substance abuse, immune-related illness, or other medical conditions such as diabetes.

Patients sustained an average of 1.8 fractures with a mean severity score of 14.0 on the Mandibular Injury Severity Score (MISS), where points are given for type and location of fracture, number of fractures, occlusion, soft tissue damage, infection, and displacement.

Forty per cent of patients required closed reduction and maxillomandibular fixation (CR-MMF) and the remainder underwent open reduction and internal fixation (ORIF), with surgery occurring a mean of 3 days after injury.

POICs included recurrent swelling, fever, pain or trismus, abscess, dehiscence with purulent drainage, exposed or infected hardware, osteomyelitis, or a fistula.

Analysis showed that risk for POIC rose significantly with increasing MISS (odds ratio [OR]=1.4), and a positive medical history (OR=1.4), after adjusting for age, medical history, time between injury and treatment, MISS, and treatment and incision types.

Dodson et al comment: "Although the clinician cannot change or modify these variables, the results reported here may be helpful in identifying subjects at increased risk for POICs and provide some insight and help in advising patients about risks of treatment."

POIC risk also increased with length of delay to surgery, although this was not statistically significant, prompting the researchers to add that "treatment of the fracture soon after injury may decrease the risk for POIC."

By Lynda Williams

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