Comparison of open reduction and internal fixation versus closed treatment in firearm-related mandibular fractures: a retrospective comparative cohort study
DOI:
https://doi.org/10.59736/IJP.24.02.1085Keywords:
Facial Asymmetry, Firearms Injury, Mandibular Fractures, Postoperative Complications, Retrospective StudiesAbstract
Background: Firearm-related mandibular fractures are increasingly encountered in tertiary care settings and are associated with complex injury patterns and significant morbidity. Optimal management remains debated, particularly between open reduction and internal fixation (ORIF) and closed treatment approaches.
Methods: This retrospective comparative cohort study was conducted at Mardan Medical Complex, Khyber Pakhtunkhwa, Pakistan, from April 2024 to December 2025. A total of 202 patients with firearm-related mandibular fractures were included and categorized into ORIF (n=157) and closed treatment (n=45) groups. Outcomes included infection, non-union, malocclusion, facial asymmetry, healing time, and functional recovery. Multivariable logistic regression was performed to adjust for confounders.
Results: Non-union (15.6% vs. 4.5%, p=0.01), malocclusion (22.2% vs. 7.6%, p=0.005), and facial asymmetry (20.0% vs. 6.4%, p=0.004) were significantly higher in the closed group. Infection rates were comparable (p=0.32). ORIF demonstrated shorter healing time and improved functional recovery. Adjusted analysis confirmed higher odds of non-union (aOR 3.82), malocclusion (aOR 2.94), and facial asymmetry (aOR 2.78) with closed treatment.
Conclusion: ORIF provides superior structural and functional outcomes compared to closed treatment in firearm-related mandibular fractures and should be preferred when feasible.
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