Risk factors associated with complications in surgical treatment of mandibular fractures: a retrospective study.

The aim of this study was to identify risk factors associated with complications following mandibular fracture open reduction and internal fixation (MORIF). The secondary purpose was to determine if a delay in surgery contributed to complications. Analysed complications were: surgical site infection (SSI), plate removal (PR), non-union (NU), repeat open reduction and internal fixation (re-ORIF), occlusal discrepancy (OD), second operation, postoperative paraesthesia (POP) and temporomandibular joint (TMJ) symptoms. Factors analysed for association were: patient factors (sex, age, smoking, alcohol, immunocompromise, recreational drug use), surgeon factors (grade), fracture factors, single vs multiple, number of fracture sites, side, displacement, horizontal favourability for angle and site of fracture, symphysis, parasymphysis (PS), body, angle and condyle ± presence of vertical shortening (VS). A retrospective cohort study of 252 patients treated, in a single centre between October 2015 and November 2023. All patients underwent MORIF ± condyle fracture open reduction and internal fixation (CORIF) ± maxillomandibular fixation (MMF). Risk factors associated with complications were: CORIF and SSI (OR (95% CI) 7.92 (1.62-77.48) p = 0.009), age and SSI (OR (95% CI) 1.03 (1.00-1.06) p = 0.029) age and OD (OR (95% CI) 1.03 (1.01-1.05) p = 0.010), condyle fracture and OD (OR (95% CI) 2.32 (1.20-4.53) p = 0.012), immunosuppression and PR (OR (95% CI) 16.41 (2.83-113.2) p = 0.003), vs condyle fracture and PR (OR (95% CI) 0.17 (0.02-0.94) p = 0.041), age and NU (OR (95% CI) 1.06 (1.02-1.10) p = 0.008), CORIF and NU (OR (95% CI): 11.25 (1.16-1491.4) p = 0.035) and immunosuppression and second operation (OR (95% CI) 5.64 (1.03-35.6) p = 0.046). There was no significant association between delay in time of surgery with any of the complications analysed, suggesting that selected mandibular fractures may be suitable for semi-elective management.