Atrophic edentulous mandible fractures: a systematic review and meta-analysis

Fractures of the atrophic edentulous mandible are uncommon but challenging, particularly in elderly patients, due to poor bone quality, reduced vascularization, and the absence of dental occlusion. The aim of this systematic review and meta-analysis was to evaluate fracture patterns, treatment strategies, and clinical outcomes of these mandible fractures, focusing on fracture location, degree of mandibular atrophy, treatment modality, and associated complications. A PRISMA-compliant systematic review was conducted. PubMed/MEDLINE, Cochrane Library, Scopus, Ovid MEDLINE, and Embase were searched (1990-2025). A single-arm meta-analysis was performed for fracture sites and complications using the Freeman-Tukey arcsine transformation. Heterogeneity and publication bias were assessed, and the robustness of the pooled estimates was evaluated by leave-one-out sensitivity analysis. Twenty-four studies encompassing 888 patients and 1279 fractures were included. The most frequent etiology was falls (≈52-55%). The mandibular body was the most affected site (pooled estimate 67%, 95% confidence interval 57-75%). Bifocal and comminuted fractures were more frequent in moderate-to-severe atrophy. The pooled overall complication rate was 19% (95% confidence interval 11-29%). Infection (3%), neurosensory disturbances (1%), and non-union (1%) were the most reported complications. Open reduction and internal fixation (ORIF) with load-bearing reconstruction plates was the predominant treatment, especially for Luhr II-III fractures; miniplates and conservative approaches were reserved for selected cases. Bone grafting was uncommon (≈1%), primarily for severe atrophy. Atrophic edentulous mandible fractures are frequently treated with load-bearing ORIF, with acceptable complication rates. A workflow-based approach integrating fracture displacement, degree of atrophy, and fracture complexity, and including the selective use of CAD/CAM planning, may support standardized, evidence-informed management.