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A protocol for the management of compound mandibular fractures based on the time from injury to treatment
P L Maloney1, R E Lincoln, C P Coyne
1Dentistry & Oral and Maxillofacial Surgery, Boston Medical Center, MA 02118, USA. Philip.Maloney@bmc.org
Purpose:
The purpose of this study was to evaluate the validity of a treatment protocol for compound mandibular fractures that is based on the time of injury to treatment.
Patients And Methods:
Fifty-two patients with 71 mandibular fractures were treated in a prospective fashion in conformity with the protocol. Thirty-seven open reductions with rigid fixation were performed on 30 patients. The remaining 22 patients were treated solely with closed reduction and maxillomandibular fixation (MMF). Forty-five patients were treated before 72 hours and 7 after 72 hours.
Results:
Fifty-one of the 52 patients healed without evidence of infection. One patient developed suppurative osteomyelitis. Thus, the bone infection rate was 1.9% for all patients treated and 3.3% for patients treated with rigid fixation (ORIF).
Conclusion:
These results underscore the validity of the treatment protocol to immobilize compound fractures within 72 hours of injury, if possible. If the initial treatment is delayed for more than 3 days, any infection at the compound fracture site(s) should first be resolved by MMF and intravenous antibiotics before performing an open reduction. This is done to ensure adequate perfusion of blood at the fracture site when the open reduction is performed.
