Fracture

Reduction-fixation of the fractured mandible: Which factors associate with a poor surgical outcome? (2017)

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Type of publication:
Conference abstract

Author(s):
*Mustafa E.; Hanu-Cernat L.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2015; vol. 53 (no. 10)

Abstract:
Introduction: Revision rates following open reduction-fixation of mandibular fractures are not widely reported. This study aims to identify fracture and occlusal patterns asso-ciated with operative difficulties and suboptimal outcomes requiring further surgical correction. Method: All patients who required revision reduction and fixation of mandible fractures at the University Hospital Coventry between November 2008 and December 2013 were identified from the theatre database. Patients treated beyond five weeks, requiring plate removal secondary to infection or those that underwent staged fixation of complex facial trauma were excluded. Radiographs, theatre entries and patient records were examinedtoidentify patient demographics, fracture patterns, operative technique and the grade of the operating surgeon. Results: The return to theatre rate in our series was 2.3% (12 cases out of 524). The need for re-intervention was primarily established on clinical grounds. Revisions were required in: 1. Patients non-compliant with diet modification advice. 2. Pre-existent class III malocclusion. 3. Condylar fractures failing conservative management. 4. Wisdom teeth or a dominant occluding molar left in the line of the fracture. 5. Dentoalveolar injury. 6. Inadequate reduction/fixation on first intervention. No correlation was noted with the timing of treatment or occlusal control. Conclusion: Cases that needed revision surgery were fairly stereotype in our series. Poor outcomes were associated with significant occlusal interferences (pre-existing malocclusions, dentoalveolar fractures or teeth retainedinthe line of fracture) and unstable fracture patterns. Awareness of these risk factors may help with the anticipation of operative difficulties and lead to improved treatment outcomes.

Unusual fracture combination in a paediatric acute ankle (combined medial talar compression fracture with medial malleolus fracture in an immature skeleton): a case report. (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, Rhee SJ, *Wagner WW

Citation:
Journal of Surgical Case Reports, 2014, vol./is. 2014/10, 2042-8812;2042-8812 (2014)

Abstract:
Talar compression fractures are uncommon orthopaedic injuries, especially in the immature skeleton. Fractures of the talar body constitute >5% of all foot and ankle fractures. The combination of a medial compression fracture and corresponding medial malleolar fracture is rare and not previously reported injury in the literature. We present a case report of a skeletally immature 15-year-old Caucasian male who sustained a medial malleolar and corresponding medial talus fracture after being ejected from his pushbike. This report outlines the potential difficulties in diagnosing an unusual fracture combination and the importance of initial management including necessary diagnostic imaging to identify such injuries. Through this case, we aim to highlight the need for having high suspicions of underlying fractures in paediatric trauma cases. The long-term complications and risks of osteonecrosis of the talus can have detrimental effect on a patient’s outcome; therefore, we also emphasize the need for regular monitoring and long-term follow-up. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. The Author 2014.