Impact Of Surgical Timing On Postoperative Complications Following Open Reduction Internal Fixation Of Mandibular Fractures

Purpose: The mandible is the second most fractured facial bone. The timing of open reduction internal fixation (ORIF) has been a subject of debate for decades. The authors sought to investigate the association between the timing of ORIF and the incidence of postoperative complications. Methods: The authors retrospectively reviewed adult trauma patients who underwent ORIF in 2018 and 2019. The authors excluded patients who underwent mandibulomaxillary fixation (MMF) only and those with postoperative follow-up <2 weeks. The duration between injury and ORIF was categorized into: <4, 4 to 7, and >7 days. The association between surgical timing categories and the incidence of postoperative complications was assessed using bivariate analyses and multivariable logistic regression. Results: Of 226 patients included, the median (interquartile range) age was 32 (25–42) years, and the median (interquartile range) follow-up was 49 (25–118) days. Most patients [207 (92%)] underwent both ORIF and MMF. Most patients had ORIF within 3 days of injury [168 (74%)]. Major postoperative complications included unplanned re-operation [n=25 (11.1%)], malocclusion [n=20 (8.8%)], and malunion [n=7 (3.1%)]. Minor postoperative complications included mental nerve paresthesia [n=79 (35%)], infection [n=30 (13.3%)], TMJ complications [n=17 (7.5%)], and wound dehiscence [n=14 (6.2%)]. Delayed ORIF >7 days of injury was associated with significantly greater odds of unplanned re-operation [adjusted odds ratio (aOR) 95% CI 10.43 (2.16–50.44), P=0.004], malocclusion [aOR (95% CI) 8.17 (1.31–51.03), P=0.025], and malunion [aOR (95% CI) 23.04 (1.18–>10), P=0.039]. Conclusion: The authors recommend early ORIF in the management of mandibular fractures to minimize postoperative complications.