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The use of rigid internal fixation in mandibular fractures complicated by osteomyelitis
M E Koury1, D H Perrott, L B Kaban
1Department of Oral and Maxillofacial Surgery, University of California, San Francisco.
Purpose:
Reports on treatment of "infected" mandibular fractures with open reduction and rigid internal fixation (RIF) consist of either isolated cases or mixed series of patients with soft tissue infections or inadequately documented osteomyelitis. The definition of "infected fracture" is often vague and may include both soft tissue or bone sepsis.
Materials And Methods:
In this retrospective study, seven patients with mandibular fractures and documented osteomyelitis were treated by a protocol that included open reduction and RIF. Technetium-99m methylene diphosphonate (99mTc) and Indium 111 (111In) radionuclide scans, bone cultures, and microscopic examination were used to document the diagnosis of osteomyelitis. The infections were treated with antibiotics, incision and drainage, and surgical debridement. Reconstruction plates that were large enough to provide four holes in each bone segment were used for RIF of the fractures and simultaneous reconstruction of the osseous defects.
Results:
After an average follow-up of 26 months, all patients remained infection free, and the fracture sites were stable. Five of the seven patients had inferior alveolar nerve dysfunction after treatment; no other significant complications were noted.
Conclusion:
The results of this study indicate that the protocol of simultaneous debridement, reduction, and RIF is a satisfactory method for treatment of mandibular fractures complicated by osteomyelitis. Prospective studies and longitudinal follow-up of larger numbers of patients would be desirable to confirm these findings.
Insights
This study shows that a protocol combining debridement, open reduction, and rigid internal fixation (RIF) effectively treats mandibular fractures with osteomyelitis, leading to stable, infection-free sites.
Area of Science:
- Oral and Maxillofacial Surgery
- Orthopedic Surgery
- Infectious Disease Management
Background:
- Existing literature on treating infected mandibular fractures with open reduction and rigid internal fixation (RIF) often lacks clear definitions of
- infected fracture
- and may combine soft tissue infections with osteomyelitis.
- This study addresses the need for a standardized protocol for managing mandibular fractures complicated by documented osteomyelitis.
Observation:
- A retrospective study evaluated seven patients with mandibular fractures and confirmed osteomyelitis.
- Diagnosis was confirmed using Technetium-99m methylene diphosphonate (99mTc) and Indium 111 (111In) radionuclide scans, bone cultures, and microscopic examination.
- Treatment involved antibiotics, incision and drainage, surgical debridement, and RIF using large reconstruction plates.
Findings:
- All seven patients remained infection-free with stable fracture sites after an average follow-up of 26 months.
- Five patients experienced inferior alveolar nerve dysfunction post-treatment.
- No other significant complications were reported.
Implications:
- The protocol of simultaneous debridement, reduction, and RIF is a viable treatment for mandibular fractures with osteomyelitis.
- Further prospective studies with larger patient cohorts are recommended to validate these findings.
- This approach offers a promising solution for complex fracture management in oral and maxillofacial surgery.