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External Fixation for Ballistic Mandibular Trauma: An Old Method for a Modern Problem.

Derek B Asserson1, Caroline S Reidy2, Mahmoud Hassouba1

  • 1Division of Plastic and Reconstructive Surgery.

Annals of Plastic Surgery
|May 11, 2026
PubMed
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External fixation for ballistic mandibular fractures offers shorter operative times and fewer long-term complications compared to internal fixation. This approach preserves blood supply and aids recovery for severe injuries.

Area of Science:

  • Oral and Maxillofacial Surgery
  • Trauma Surgery
  • Reconstructive Surgery

Background:

  • Ballistic mandibular fractures present complex challenges due to comminution, compromised vascularity, and contamination.
  • Traditional rigid internal fixation may be hindered by these factors.
  • External fixation, a less invasive method, preserves periosteal blood supply but lacks direct comparative data in ballistic trauma.

Purpose of the Study:

  • To compare the outcomes of external fixation versus internal fixation for treating ballistic mandibular fractures.
  • To evaluate short-term and long-term complication rates associated with each fixation method.

Main Methods:

  • Retrospective review of patients with gunshot-related mandibular fractures (January 2020 - August 2024).
  • Patients were divided into external fixation (n=10) and internal fixation (n=30) groups.
Keywords:
ballistic traumaexternal fixationgunshot woundmandible fractureperiosteal blood supply

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  • Complications assessed up to 6 months; multivariable logistic regression used for long-term analysis.

    • Main Results:

    • External fixation group had significantly shorter operative times (118.5 vs. 194.5 min, P=0.01).
    • Initial short-term complications were higher in the external fixation group (80% vs. 33.3%, P=0.001), reflecting injury severity.
    • Long-term complication rates were lower with initial external fixation (10% vs. 33.3%) and trended towards statistical significance on multivariable analysis.

    Conclusions:

    • Initial external fixation is associated with reduced operative time and lower long-term complication rates for ballistic mandibular fractures.
    • External fixation serves as a viable staged approach, preserving vascularity and facilitating soft tissue healing before definitive reconstruction.