title: Are open mandibular fractures still an emergency?
abstract: BACKGROUND
  Early surgical management is often advocated for fractures of the tooth-bearing portion of the mandible. A 6-hour delay has been mentioned for the fixation of these fractures. Our aim was to bring this paradigm into question.
  
  
  METHODS
  All patients referred to our department from September 2012 to May 2014 for fractures of the tooth-bearing portion of the mandible were retrospectively included. For each patient, age, gender, aetiology of the fracture, and characteristics of the fractures were recorded. Tobacco and/or alcohol addictions, diabetes and mandibular dental condition were taken into account. We also noticed the preoperative delay and the occurrence of complications such as: haematoma, infection, wound dehiscence, osteosynthesis failure and pseudarthrosis.
  
  
  RESULTS
  Among the 47 patients referred, 36 were treated with a delay of more than 6 hours (76.6%). In 88.8% of the cases, the reason for this delay was unavoidable. The mean delay time from trauma to surgery was 52 hours (range: 7-312). Forty-nine percent of the patients had comorbidities. Complications occurred in 6 patients leading to an overall complication rate of 16.67%. A statistically significant higher complication rate was observed among smokers (P=0.006). No statistical relationship was found between the delay and the occurrence of complications (P=0.994). This study suggests that fractures of the tooth-bearing portion of the mandible should no longer be considered as an emergency that must be treated within a 6-hour delay.
authors.affiliation: Division de chirurgie maxillo-faciale, BH07, CHUV, rue du Bugnon 46, 1011 Lausanne, Switzerland. Electronic address: hugues.zrounba@chuv.ch.
authors.forename: H
authors.initials: H
authors.lastname: Zrounba
authors.affiliation: Division de chirurgie maxillo-faciale, BH07, CHUV, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Hoarau
authors.affiliation: Division de chirurgie maxillo-faciale, BH07, CHUV, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Zweifel
authors.affiliation: Division de chirurgie maxillo-faciale, BH07, CHUV, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Lanthemann
authors.affiliation: Division de chirurgie maxillo-faciale, BH07, CHUV, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Broome
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000706:statistics & numerical data; D005597:Fractures, Open / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D019248:Jaw Fixation Techniques / Q000706:statistics & numerical data; D008297:Male; D008334:Mandible / Q000601:surgery; D008337:Mandibular Fractures / Q000453:epidemiology / Q000601:surgery*; D008338:Mandibular Injuries / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Complications; Délai au traitement; Fractures mandibulaires; Mandibular fractures; Maxillomandibular fixation; Time-to-treatments