Interosseous wiring of fractures of the mandible

Abstract

THE best results are obtained in the treatment of fractures of the mandible when perfect reduction and immobilisation are achieved and local infection does not occur. In a proportion of patients, however, the fulfilment of these ideals is almost impossible in spite of the careful application of standard methods of treatment, and in these the results leave much to be desired. In this department, during the period September i95i to September 1953, thirty of these difficult cases out of a total of 215 cases of mandibular fracture were treated by open reduction and interosseous wiring. It may be objected that this method carries a risk of bone infection which, in theory, is increased by the introduction of a foreign body in the form of a wire close to the fracture line. Experience has shown, however, that if certain precautions are taken this danger is practically non-existent ; in fact, the results have proved so satisfactory that it has been decided to record some observations which may be of value to others working in this field. The only reference to the use of interosseous wiring which we have found in the British literature is that of Fry et al. (1943), who recommended the surgical wiring of the bone ends when freshening and approximation were carried out in cases of non-union. In the American literature, Gordon (1947) discussed the use of this method in the treatment of forty-eight fractures in forty-six patients, and although many cases of war injury were included, serious infection occurred only in two. Thoma (1948) referred to early failures, and attributed the increased safety of this procedure to the introduction of stainless steel and tantalum wire, and to the use of penicillin and efficient immobilisation.