Is the Use of Arch Bars or Interdental Wire Fixation Necessary for Successful Outcomes in the Open Reduction and Internal Fixation of Mandibular Angle Fractures?

Abstract

The purpose of this retrospective cohort study was to analyze the complications associated with a series of mandibular angle fractures treated by open reduction and internal fixation and to determine if the method of intraoperative maxillomandibular fixation (MMF) affected patient outcome. The records of 162 consecutive patients with isolated mandibular fractures that were treated by the senior author (R.B.B.) with open reduction and internal fixation were retrospectively reviewed and a number of clinical variables were recorded. Of these, all patients with fractures involving the mandibular angle, alone or in combination with other mandibular fractures, were identified. Only patients in the permanent dentition with angle fractures treated with a single 2.0 mm titanium plate placed at the superior border using standard Champy technique were included in the study. Patients with less than 6 weeks follow-up, concomitant midface fractures, edentulous patients, patients with comminuted fractures or gunshot wounds, and those patients presenting with infected fractures were excluded from the primary study group, which totaled 75 patients with 83 angle fractures. Postoperative complications, including infection, malunion/nonunion, wound dehiscence, osteomyelitis, pain, and the need for secondary operative intervention, were tabulated. For purposes of comparison, patients were divided into 3 groups based upon the type of intraoperative MMF utilized: group 1, Erich arch bars (n = 24); group 2, 24 gauge interdental "Stout" wires (n = 25); and group 3, manual reduction alone (n = 26). Outcome measures were defined as successful bone healing, acceptable occlusion, minor complications, and major complications. Descriptive statistics were recorded and an analysis of variance was calculated to evaluate differences between the 3 groups. The Fisher's exact test was used to evaluate whether a complication occurred more frequently in any one particular group. The mean age of the 75 patients included in the study was 28.2 years (M = 63, F = 12) and there were no significant demographic differences between the 3 groups (P = 0.22). All patients eventually achieved successful bony union with an acceptable occlusion. Thirty-two percent of patients in the cohort required a second procedure, usually outpatient removal of loose or symptomatic hardware under local anesthesia or intravenous sedation, but there was no difference in re-operation rate based upon the method of intraoperative fixation (P = .47). Major complications occurred in 2 patients that required secondary operations due to malunion and nonunion (2.7%). Twenty-two minor complications occurred in 16 patients (21.3%) and were evenly distributed amongst the 3 groups (P = .074), including infection (n = 4), wound dehiscence (n = 1), and/or symptomatic hardware (n = 16) that required hardware removal. All of the minor complications were treated in an outpatient setting under local anesthesia or under intravenous sedation. When the complications were pooled together, the Fisher exact test again yielded no difference in complications between the 3 groups (P = .33). The use of Erich arch bars or interdental wire fixation to assist with MMF during the open reduction and internal fixation of noncomminuted mandibular angle fractures treated in Champy fashion is not always necessary for successful outcome.