A protocol for the management of compound mandibular fractures based on the time from injury to treatment

Purpose: The purpose of this study was to evaluate the validity of a treatm ent protocol for compound mandibular fractures that is based on the time of injury to treatment. Patients and Methods: Fifty-two patients with 71 mandibular fractures were treated in a prospective fashion in conformity with the protocol. Thirty-se ven open reductions with rigid fixation were performed on 30 patients. The remaining 22 patients were treated solely with closed reduction and maxillo mandibular fixation (MMF). Forty-five patients were treated before 72 hours and 7 after 72 hours. Results: Fifty-one of the 52 patients healed without evidence of infection. One patient developed suppurative osteomyelitis. Thus, the bone infection rate was 1.9% for all patients treated and 3.3% for patients treated with r igid fixation (ORIF). Conclusions: These results underscore the validity of the treatment protoco l to immobilize compound fractures within 72 hours of injury, if possible. If the initial treatment is delayed for more than 3 days, any infection at the compound fracture site(s) should first be resolved by MMF and intraveno us antibiotics before performing an open reduction. This is done to ensure adequate perfusion of blood at the fracture site when the open reduction is performed. (C) 2001 American Association of Oral and Maxillofacial Surgeon s.