The use of rigid internal fixation in mandibular fractures complicated by osteomyelitis.
OBJECTIVE
Reports on treatment of "infected" mandibular fractures with open reduction and rigid internal fixation (RIF) consist of either isolated cases or mixed series of patients with soft tissue infections or inadequately documented osteomyelitis. The definition of "infected fracture" is often vague and may include both soft tissue or bone sepsis.


METHODS
In this retrospective study, seven patients with mandibular fractures and documented osteomyelitis were treated by a protocol that included open reduction and RIF. Technetium-99m methylene diphosphonate (99mTc) and Indium 111 (111In) radionuclide scans, bone cultures, and microscopic examination were used to document the diagnosis of osteomyelitis. The infections were treated with antibiotics, incision and drainage, and surgical debridement. Reconstruction plates that were large enough to provide four holes in each bone segment were used for RIF of the fractures and simultaneous reconstruction of the osseous defects.


RESULTS
After an average follow-up of 26 months, all patients remained infection free, and the fracture sites were stable. Five of the seven patients had inferior alveolar nerve dysfunction after treatment; no other significant complications were noted.


CONCLUSIONS
The results of this study indicate that the protocol of simultaneous debridement, reduction, and RIF is a satisfactory method for treatment of mandibular fractures complicated by osteomyelitis. Prospective studies and longitudinal follow-up of larger numbers of patients would be desirable to confirm these findings.
Department of Oral and Maxillofacial Surgery, University of California, San Francisco.
M E
ME
Koury
D H
DH
Perrott
L B
LB
Kaban
D000328:Adult; D001860:Bone Plates; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000150:complications* / Q000601:surgery*; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D061221:Trigeminal Nerve Injuries