Impact of patient-related factors on complications when treating mandibular fractures by load-sharing and load-bearing osteosynthesis

Rupinder K Sarai; Eiling Wu; Asad Ahmed; Rhodri Williams; John Breeze

doi:10.1016/j.bjoms.2023.03.003

Impact of patient-related factors on complications when treating mandibular fractures by load-sharing and load-bearing osteosynthesis

Br J Oral Maxillofac Surg. 2023 May;61(4):284-288. doi: 10.1016/j.bjoms.2023.03.003. Epub 2023 Mar 15.

Authors

Rupinder K Sarai¹, Eiling Wu², Asad Ahmed², Rhodri Williams², John Breeze³

Affiliations

¹ Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK. Electronic address: r.sarai@nhs.net.
² Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
³ Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK; Royal Centre for Defence Medicine, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.

PMID: 37031044
DOI: 10.1016/j.bjoms.2023.03.003

Abstract

The decision about the choice of load-sharing (LS) or load-bearing (LB) osteosynthesis is determined by an interplay of fracture-related and patient-related factors. In some situations a similar fracture in two different patients may be treated successfully by either of these methods. Our aim was to identify preoperative patient-related factors that may assist in deciding which form of osteosynthesis is employed. All adult patients who underwent open reduction and internal fixation of mandibular fractures (excluding condyle) between 1 October 2018 and 1 June 2021 were retrospectively identified. The odds of developing postoperative complications and requiring a return to theatre (RTT) were calculated for each method of fixation together with the following patient factors: smoking, excess alcohol, substance misuse, and severe mental health issues. Of 337 fractures treated using LS principles, 27 (8%) developed complications, of which 20 (6%) required a RTT for repeat osteosynthesis. Of 74 fractures treated using LB principles, seven (10%) developed complications and two (3%) required a RTT for repeat osteosynthesis. The only patient factor that had statistically significant increased odds of a complication requiring RTT was LS osteosynthesis in patients who admitted drinking excess alcohol (OR = 7.83, p = 0.00, 95% CI = 3.13 to 19.60). Complications when treating mandibular fractures are rarely reported in the literature, and lack standardisation in their clinical significance. Figures generally represent overall numbers of patients, whereas the number of individual fractures treated is more accurate. In our study complications occurred in 8% of treated fractures and 10% of patients. The RTT rate was 7% of patients, which compares favourably with a recently stated standard of 10% of patients, as suggested by the Getting it Right First Time (GIRFT) report.

Keywords: Complication; Fixation; Load-bearing; Load-sharing; Mandible; ORIF; Patient factors; Plating.

MeSH terms

Adult
Bone Plates
Fracture Fixation, Internal / adverse effects
Fracture Fixation, Internal / methods
Humans
Mandibular Fractures* / etiology
Mandibular Fractures* / surgery
Open Fracture Reduction / adverse effects
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies
Treatment Outcome