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Mandibular fractures in an American inner city: the Harlem Hospital Center experience
1Plastic Surgery Section, Harlem Hospital Center, New York, New York 10037.
Insights
Mandibular fractures in inner cities are primarily caused by blunt trauma from drug-related violence. Treatment should involve antibiotics, improved oral hygiene, and nutrition.
Area of Science:
- Oral and Maxillofacial Surgery
- Trauma Surgery
- Public Health
Background:
- Mandibular fractures represent a significant injury, particularly in urban settings.
- Previous studies indicated varied etiologies, but recent trends suggested a rise in violence-related trauma.
Purpose of the Study:
- To analyze the causes, common sites, and treatment outcomes of mandibular fractures.
- To identify the predominant mechanisms of injury in a specific urban population.
Main Methods:
- Retrospective chart review of 116 patients treated for mandibular fractures.
- Data collection included patient demographics, injury mechanisms, fracture locations, and treatment modalities.
- Analysis of complication rates in relation to treatment and patient factors.
Main Results:
- Assaults (fists, blunt objects) were the leading cause of injury (33%).
- The body (46%) and angle (22%) of the mandible were the most frequently fractured sites.
- Intermaxillary fixation was the most common treatment (55%), with open reduction showing a low complication rate (15%) even in patients with poor hygiene and substance abuse.
Conclusions:
- Blunt trauma from drug-related violence is a major cause of mandibular fractures in inner-city populations.
- Effective treatment strategies should incorporate prophylactic antibiotics, enhanced oral hygiene, and nutritional support.
Abstract:
A retrospective study of 116 patients treated at Harlem Hospital for mandibular fractures between 1984 and 1987 was performed. Men comprised 84% of the population studied. The mechanisms of injury were assault with fists and blunt objects (33%), falls (10%), kicking (3%), penetrating injuries (3%), and vehicular accidents (1%). The body of the mandible (46%) and the angle (22%) were the most common fracture sites. Intermaxillary fixation with arch bars was the most frequent method of treatment (55%), followed by open reduction and internal fixation (33%). The complication rate with open reduction was relatively low (15%) despite the fact that 73% of these patients were heavy drug or alcohol abusers with documented poor oral hygiene. This study further substantiates the findings that in the poor inner cities, blunt trauma from drug-related violence has become the major cause of mandibular fracture. Treatment of these patients should include prophylactic broad-spectrum antibiotics, improved oral hygiene, and supplemental nutrition.