What Factors Are Associated With Open Treatment of Pediatric Mandibular Fractures?

PURPOSE: There is a paucity of data with respect to management of pediatric facial fractures. The purpose of this study was to describe the population of pediatric patients with mandibular fractures at our institution and to assess predictors of fractures requiring open reduction and internal fixation (ORIF).

PATIENTS AND METHODS: This was a retrospective cohort study of patients aged ≤17 years presenting with mandibular fractures. The primary predictor variable was age ≥13 years and <13 years. The primary outcome variable was ORIF (yes or no). Epidemiologic factors and complications were also assessed. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between predictor variables and ORIF.

RESULTS: The study sample was composed of 84 subjects with 61 subjects aged ≥13 years and 23 subjects aged <13 years. ORIF was used for 21.4% of subjects. Increased age was associated with ORIF (P = .009). After adjusting for the effects of concurrent variables, age (P = .047, OR = 2.30, 95% CI = 1.01 to 5.24), fracture displacement between 2 and 4 mm (P = .032, OR = 18.1, 95% CI = 1.29 to 254), fracture displacement >4 mm (P = .019, OR = 16.9, 95% CI = 1.60 to 179), and the presence of 3 fractures (P = .027, OR = 30.8, 95% CI = 0.001 to 0.641) were positive independent predictors of ORIF. Concomitant facial, skull, or skull base fractures (P = .039, OR = 0.027, 95% CI = 0.001 to 0.641) were a negative independent predictor of ORIF. Secondarily, both mechanism of injury and fracture location varied significantly by age and gender. Complication rate was 6.33%.

CONCLUSIONS: Most pediatric mandibular fractures were managed nonoperatively. Increased age, fracture displacement, presence of 3 fractures, and concomitant craniofacial injuries were independent predictors of ORIF. Complication rates were low regardless of treatment modality.