Evaluation of delayed versus immediate bone reduction with rigid internal fixation for high-velocity ballistic maxillofacial injuries with severely comminuted fractures
DOI:
https://doi.org/10.18203/2349-2902.isj20260128Keywords:
Maxillofacial trauma, Ballistic injuries, Rigid fixation, Delayed osteosynthesis, Facial fracturesAbstract
Background: High-velocity ballistic maxillofacial injuries cause extensive bone comminution and soft-tissue destruction. Determining the optimal timing of definitive fixation remains controversial, especially in contaminated wounds. To compare infection rate, bone-healing complications, and functional recovery between immediate and delayed bone reduction with rigid internal fixation in severely comminuted ballistic maxillofacial injuries.
Methods: A retrospective cohort study of 90 patients treated between 2011 and 2013 at Tishreen Military Hospital, Damascus, Syria was conducted. Group A (n=32) received immediate fixation (< 24 h); Group B (n=58) underwent delayed fixation (7–21 days) after staged debridement and stabilization. Outcomes included infection, non-union/malunion, and six-month functional success. Analyses used chi-square tests, absolute-risk reduction (ARR), and number-needed-to-treat (NNT).
Results: Delayed fixation reduced infection (10% vs 41%), non-union/malunion (8% vs 35%), and improved function (93% vs 60%). ARR values were 31%, 27%, and 33%, respectively.
Conclusions: In severely comminuted high-velocity ballistic facial injuries, delayed rigid fixation following thorough debridement yields fewer complications and better functional outcomes than immediate fixation.
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References
Boffano P, Roccia F, Zavattero E. Gunshot injuries to the maxillofacial region: a review of the current literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(5):678-89.
Manson PN, Hoopes JE, Su CT. Structural approach to management of Le Fort fractures. Plast Reconstr Surg. 1980;66(1):54-62. DOI: https://doi.org/10.1097/00006534-198007000-00011
Motamedi MH. Primary and secondary management of maxillofacial gunshot injuries. J Oral Maxillofac Surg. 2003;61(12):1390-8. DOI: https://doi.org/10.1016/j.joms.2003.07.001
Cunningham LL, Haug RH, Ford J. Firearm injuries to the maxillofacial region: an overview of current thoughts regarding demographics, pathophysiology, and management. J Oral Maxillofac Surg. 2003;61(8):932-42. DOI: https://doi.org/10.1016/S0278-2391(03)00293-3
Kaufman Y, Cole P, Hollier LH. Facial gunshot wounds: trends in management. Craniomaxillofac Traum Reconstruct. 2009;2(2):85-90.
Kaufman Y, Cole P, Hollier LH Jr. Facial gunshot wounds: trends in management. Craniomaxillofac Trauma Reconstr. 2009;2(2):85-90. DOI: https://doi.org/10.1055/s-0029-1202595
Holmes JD. Gunshot injuries. Peterson’s Principles of Oral and Maxillofacial Surgery. Shelton, CT. 2012:625-39.
Rodriguez ED. Early versus delayed reconstruction of severe craniofacial trauma. Plastic Reconstruct Surg. 2011;127(2):693-705.
Guevara C. Maxillofacial gunshot injuries: a comparison of civilian and military injuries. J Oral Maxillofac Surg. 2016;74(3):584-92.
Fonseca RJ, Walker RV, Barber HD, Powers MP, Frost DE. Oral and Maxillofacial Trauma. St Louis: Elsevier. 2013:745-60.
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