Predictors for complications and the removal of osteosynthesis material after mandibular fractures: a retrospective analysis

This study aimed to identify factors leading to postoperative complications after open reduction and internal fixation (ORIF) of mandibular fractures. In addition, predictors associated with plate removal after surgery were identified. This retrospective single-center cohort study included adult patients who underwent primary ORIF of mandibular fractures between 12/2017 and 12/2019. Demographic and clinical data were extracted from medical records. The primary outcome was postoperative surgical site– and hardware-related complications, defined as wound healing disorder, surgical site infection, fistula formation, or plate exposure. The secondary outcome was removal of osteosynthesis material. Multivariable logistic regression analysis was used to identify independent predictors for both outcomes. A total of 377 patients were included. Postoperative surgical site– or hardware-related complications occurred in 17.0% of patients. Osteosynthesis material was removed in 112 patients (29.6%) during follow-up. The most frequent indication for removal was patient request without medical complaints (48.6%), followed by sensory disturbance (20.7%) and infection (18.9%). In multivariable analysis, falls as trauma mechanism were associated with a lower risk of postoperative complications (p < 0.05). Younger age (< 65 years; p < 0.01) and the occurrence of any postoperative complication (p < 0.01) were independently associated with subsequent osteosynthesis removal. Plate removal is more likely in cases with complications and in patients < 65 years. Further research is needed to investigate whether and to what extent a second operation for osteosyntheses removal is really necessary.