Challenging the Paradigm: Rates of Mandibular Infection Following Fracture

Little consensus exists regarding the proper timing of mandibular fracture fixation. Given the proximity of the oral flora to the mandible, many surgeons advocate for early fixation to mitigate infection risk. This retrospective study evaluates the safety of treating mandible fractures in a subacute period. After institutional review board approval, a retrospective analysis was performed of all mandibular fractures presented to a single center from 2013 to 2023. Patient, injury, medical, and operative details were reviewed. Area deprivation index (ADI) was used to approximate patient socioeconomic disadvantage. Data analysis included χ 2 , univariate, and logistic regression. Six hundred forty patients were analyzed. Most were male (75.8%) with an average age of 39.2 years. The mandibular body and angle were the most common fracture sites. On average, patients underwent surgery 6.9 days postinjury, with 49.7% undergoing ORIF. The average antibiotic duration was 11.7 days. Infection occurred in 3.8% of patients and typically presented in postoperative month 3. Injury mechanism, history of smoking, and treatment with oral clindamycin were found to be significant predictors of mandible infection ( P <0.005) on logistic regression. Time from injury to the operating room, time from injury to antibiotics, duration of antibiotics, fracture location, and patient ADI had no influence on infection rate. Although time from injury to the operating room was previously thought to influence the infection rate, our study demonstrated no increased risk of infection with subacute mandibular fracture management. Factors completely out of the control of the surgeon, including patient comorbidities and mechanism of injury, may pose a greater risk than previously recognized.