A comparative study of 3 treatment modalities for mandibular angle fractures

Abstract

Introduction: The mandibular angle fracture remains one of the most common mandibular fractures with a reported incidence of ~20 – 40%. Its treatment is rife with controversy with a reported global complication rate of ~30%. Aim: The purpose of the study is to determine the optimum management of the compound, isolated mandibular angle fracture. Methods and materials: A prospective, randomised, study was carried out within the department where all cases of isolated, compound, mandibular angle fractures were allocated to 1 of the three treatment groups: Group1: Superior border wire; Group2: Single miniplate; Group3: Double miniplate. The patients were assessed for the presence of post-operative infection, malocclusion and fixation failure and the outcomes were correlated. The data was analysed statistically and reported upon using STATA. Results: 75 patients were included in the study with 25 patients per group. Complication rates were equal between the miniplate groups (16%), with the Superior border wire having the best outcomes. The average ―days to surgical fracture repair post-injury‖ (p = 0.08) and the category of ―severely displaced fractures‖ (>5mm) are the factors shown to increase the incidence of complications, p = 0.02. Overall a 13.3% complication rate was noted. Conclusion: The use of 2 miniplates seems to offer no benefit over a single miniplate. In stark contrast to previous global findings, fixation using a superior border wire with intermaxillary fixation (IMF) showed the best outcomes with a 92% success rate and its usage should be reaffirmed as a cost-effective alternative in a resource-constrained environment.