A Systematic Review and Meta-Analysis of Fracture-Related Infections in Maxillofacial Trauma: Incidence, Risk...

Background/Objectives: Fracture-related infections (FRIs) are a significant complication in maxillofacial trauma, leading to adverse outcomes such as prolonged healing, nonunion, and osteomyelitis. Despite advancements in surgical techniques, the incidence of FRIs remains concerning, particularly for mandibular fractures. This systematic review and meta-analysis aims to evaluate the incidence, risk factors, and management strategies for FRIs in oral and maxillofacial trauma. Methods: A systematic search of Medline and Embase databases was conducted, including studies up to February 2024, adhering to PRISMA guidelines. Eligible studies included randomized controlled trials, cohort studies, and case-control studies focusing on the incidence, risk factors, or treatment outcomes of FRIs. Data on patient demographics, fracture type, infection rates, and management strategies were extracted and analyzed. Statistical analyses included pooled infection rates, stratified by anatomical sites, using fixed and random-effects models. Results: A total of 72 studies were included, with a pooled FRI rate of 5.6%. Mandibular fractures exhibited the highest infection rate at 8.9%, while midface fractures had the lowest at 0.9%. The significant risk factors identified included smoking, substance abuse, and comorbidities such as diabetes. Delayed surgical intervention and poor periodontal health were also associated with higher infection rates. The use of prophylactic antibiotics did not show significant differences in infection prevention. Conclusions: FRIs in maxillofacial trauma are influenced by multifactorial risks, including anatomical, patient-specific, and procedural factors. Mandibular fractures are particularly vulnerable, requiring targeted preventive strategies and timely intervention. Standardized definitions and guidelines are essential for improving consistency in diagnosis and management. Future research should focus on high-quality trials to establish evidence-based approaches for FRI prevention and treatment.