Treatment of mandibular compound-comminuted fractures

Min, Seung Ki; Oh, Sung Hwan; Kwon, Kyung Hwan; Choi, Moon Gi; Lee, Kyong Seuk; Kang, Moon Jeong

Abstract

A comminuted fracture is one in which multiple fragments of bone are created in a single anatomic site. Comminuted fractures are the consequence of high-energy impact. A fracture is classified into complex when there is concurrent injury to contiguous structures such as the maxillofacial tissues and dentition. When lines of fracture communicate with either the oral or external environment, the fracture is classified into compound. Compound comminuted mandibular fracture is defined as the presence of multiple fracture lines with open wound resulting in many small pieces within the same area. Compound comminuted fractures of the mandible have been treated by a number of methods, including closed reduction, external pin fixation, internal wire fixation, and more recently, open reduction and internal stable fixation using plate and/or screws. Historically, the accepted theory was that one should not open these injuries because open reduction would strip the blood supply to the osseous fragments, resulting in sequestration and infection. However, this theory was challenged by Kazanjian. Kazanjian stated that the majority of nonunited fractures are due to inadequate immobilization of comminuted fragments of bone, and subsequent infection, rather than to initial loss of bone. Thus open reduction and stable internal fixation using plates and/or screws has been advocated for compound comminuted fractures. The record of 52 patients treated for fractures of the mandible at Wonkwang univ. during 10 years period were reviewed in this retrospective study. The symphysis was the most commonly affected sites. The main etiology of the fractures was traffic accident. The most of fractures were treated with open reduction and internal stable fixation using long hole miniplates. Complications has been occurred in 5.8% of fractures. The major complications was infection on the fractured site.