title: Influence of perioperative dexamethasone on delayed union in mandibular fractures: A clinical and radiological study.
abstract: BACKGROUND
  The aim was to clarify the occurrence of delayed union after surgical treatment of mandibular fracture and investigate whether an association exists between perioperative use of dexamethasone and delayed union.
  
  
  METHODS
  Thirty-seven patients were included in a prospective randomized study. Of these patients, 19 (51.4%) were randomized to receive a total dose of 30 mg of dexamethasone and 18 (48.6%) served as controls. Patients underwent clinical and radiological investigation immediately, one month, three months and six months postoperatively. Radiographs were evaluated by an experienced, blinded senior oral radiologist.
  
  
  RESULTS
  Delayed fracture union was found in 9 patients (24.3%). It was associated significantly with angle fractures (p=0.012). Delayed union occurred more frequently in patients who received dexamethasone (36.8%) than in those who did not (11.1%) (p=0.068). The association of infection with delayed union was significant (p=0.027). Moreover, dexamethasone was significantly (p=0.019) associated with delayed fracture union with concomitant infection. Gender, age group, smoking habit, treatment delay and duration of surgery were not associated with delayed union.
  
  
  CONCLUSIONS
  Infection was associated with delayed union. Short-term high-dose dexamethasone predisposed to complicated fracture union, especially in patients with angle fractures. The relationship between dexamethasone and delayed bone healing without infection remains unresolved.
authors.affiliation: Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, P.O. Box 293, HUCH, Finland, johanna.snall@helsinki.fi.
authors.forename: Johanna
authors.initials: J
authors.lastname: Snäll
authors.forename: Satu
authors.initials: S
authors.lastname: Apajalahti
authors.forename: Anna-Liisa
authors.initials: AL
authors.lastname: Suominen
authors.forename: Jyrki
authors.initials: J
authors.lastname: Törnwall
authors.forename: Hanna
authors.initials: H
authors.lastname: Thorén
mesh_terms: D000293:Adolescent; D000328:Adult; D003907:Dexamethasone / Q000009:adverse effects*; D005260:Female; D017102:Fracture Healing / Q000187:drug effects*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone