Abstract
Objective: To analyze cases of compound, unfavorable and non-comminuted mandibular angle fractures treated by trans-osseous wiring, presenting postoperative complications, in a low resource center.Materials and methods: This was a 13-year retrospective study of 1,324 fractures in 1,317 subjects. The predictor variables were age, gender, aetiology, time lag between injury and treatment, and concomitant mandibular and midfacial fractures. The outcome variable was the development of complication(s) after treatment. Descriptive and bivariate statistics were computed with EPI INFO 7 version software, and the P value was set at 0.05.Results: The sample size was composed of 63/1317 (4.8%) of patients with complications. There were 48 males and 15 females with male: female ratio of 3.2:1. The age of the patients ranged from 21 to 62 years (mean 37.4± 5.6 years). The test of significance showed statistically significant association between complications of mandibular angle fractures and increasing age (P<0.002), male gender (P<0.001), road traffic accident (P<0.001), longer time lag between injury and treatment of fractures (P<0.000), and concomitant mandibular fractures (P<0.000). Deranged occlusion (n=19, 28.8%) and limited mouth opening <35mm (n=16, 24.2%) were the common complications. The complications were successfully treated during follow-up.Conclusion: The use of trans-osseous wire osteosynthesis gave good results, and can still be useful in centres that are less well equipped and where access to rigid internal fixation with mini plates is either limited or unavailable. Funding: Self-fundedKeywords: Mandible, angle, fracture, trans-osseous wiring, complications
Highlights
A total of 1,317 patients with 1,324 mandibular angle fractures were included in the study, and 63 patients had complications after treatment
This study shows that following the treatment of compound, unfavorable and non-comminuted mandibular angle fractures caused by Road traffic accidents (RTA) and assault by trans-osseous wiring and inter-maxillary fixation, complications occurred in certain subjects, and increased with increasing age, male gender, RTA, longer time lag between injury and treatment of fractures, and when there are associated concomitant mandibular fractures
The complication rate of 4.8% obtained is within the range of 0-32.0% that was earlier reported when hard-ware osteosynthesis was used as a method of fixation; these previous studies were not restricted to compound, unfavorable and noncomminuted mandibular angle fractures.[7,8,15,16]
Summary
The mandibular angle is a triangular and weak region of the mandible that is prone to fracture following high velocity impact.[1, 2] The angle fractures are among the most common mandibular fracture, accounting for about 30% of all mandibular fractures.[3,4,5] This is due to the presence of a thinner cross-sectional area of the angle relative to the neighboring segments of the mandible, and the third molars, those that are impacted, which weaken the region.[1,2,3] When these fractures occur they present with varying degrees of displacement of the fractured bone segments due to the influence of displacing forces within the oro-facial region that determine their positions. This is because some fractures could not be satisfactorily treated with closed reduction techniques no matter how ingenious the techniques might be
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