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Effect of treatment delay on mandibular fracture infection rate
Marcin Czerwinski1, Wendy L Parker, José A Correa
1Montreal, Quebec, Canada From McGill University Health Center, the Department of Mathematics and Statistics, McGill University, Montreal Children's Hospital, Jewish General Hospital, St. Mary's Hospital, and Royal Victoria Hospital.
Background:
The incidence of infection secondary to mandibular fractures ranges from 0 to 30 percent, resulting in significant sequelae. Unlike other variables that may influence infection, delayed repair is often unavoidable. The objective of this study was to accurately identify the effect of treatment delay on mandibular fracture infection rate by adjusting for confounders, thus providing strong evidence for preoperative management of these patients.
Methods:
A retrospective review of mandibular fracture patients treated at the Montreal General Hospital was performed. Length of time delay between injury and operative intervention (< or = 72 hours and > 72 hours) and presence of infection were noted. Logistic regression was used to analyze the effect of treatment delay on infection, after adjustment for covariates.
Results:
One hundred seventy-seven patients fulfilled the selection criteria and had complete records. The overall incidence of infection was 14 percent (95 percent confidence interval, 8.8 to 18.8 percent). Multiple logistic regression showed no evidence (odds ratio, 2.96; 95 percent confidence interval, 0.87 to 10.1) (p = 0.08) that treatment delay of more than 72 hours is a significant predictor of infection. The incidence of nonunion was 36 percent in the infection group (95 percent confidence interval, 17.2 to 54.8 percent) and 0 percent in the no-infection group.
Conclusions:
Infections following mandibular fractures frequently require extended treatment and significantly increase costs. These results show that delay of mandibular fracture treatment greater than 72 hours does not significantly increase infection risk. Repair should occur promptly after the injury. If that is not possible, the standard patient management should not be altered, as the benefits of doing so are unproven.
