Mandibular fractures in an American inner city : the Harlem Hospital Center Experience

A retrospective study of 116 patients treated at Harlem Hospital for mandibular fractures between 1984 and 1987 was performed. Men comprised 84% of the population studied. The mechanisms of injury were assault with fists and blunt objects (33%), falls (10%), kicking (3%), penetrating injuries (3%), and vehicular accidents (1%). The body of the mandible (46%) and the angle (22%) were the most common fracture sites. Intermaxillary fixation with arch bars was the most frequent method of treatment (55%), followed by open reduction and internal fixation (33%). The complication rate with open reduction was relatively low (15%) despite the fact that 73% of these patients were heavy drug or alcohol abusers with documented poor oral hygiene. This study further substantiates the findings that in the poor inner cities, blunt trauma from drug-related violence has become the major cause of mandibular fracture. Treatment of these patients should include prophylactic broad-spectrum antibiotics, improved oral hygiene, and supplemental nutrition.