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

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.
• 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.