Wrist external fixator for treatment of comminuted mandible fracture caused by gunshot wound: A case report

Authors

DOI:

https://doi.org/10.33448/rsd-v13i5.45733

Keywords:

External fixators; Jaw fractures; Gunshot wounds.

Abstract

Gunshot wounds may cause extensive damage to the facial skeleton, generating complex fractures. Cases of great bone comminution and poor stability can be a challenge with rigid internal fixation. Thus, the use of an external fixator is indicated. The aim of this study is to report a case of a wrist external fixator for initial treatment of a gunshut injury. A 58-year-old male patient was found on the street with extensive comminution and significant mobility of the mandibular bone, tooth loss, crown-root fractures, multiple metal fragments and a firearm projectile lodged in his face. The treatment implemented was surgical debridement with removal of foreign particles, unviable fragments and submental projectile. Next, wrist external fixator was installed bilaterally in the mandible. Good stability of the bone segments was achieved, in addition to preventing bone displacement into the airways. The use of an external fixator is a viable alternative for Traumatology services and can be useful in urgent cases like this one, allowing subsequent refined reconstructions.

References

Alencar, M. G. M. de, Bortoli, M. M. De, Silva, T. C. G. da, Silva, E. D. de O. e, & Laureano Filho, J. R. (2018). Suitability of Wrist External Fixator for Treatment of Mandibular Fracture. Journal of Craniofacial Surgery, 29(4), e371–e372. https://doi.org/10.1097/SCS.0000000000004375

Braidy, H. F., & Ziccardi, V. B. (2009). External Fixation for Mandible Fractures. Atlas of the Oral and Maxillofacial Surgery Clinics, 17(1), 45–53. https://doi.org/10.1016/j.cxom.2008.10.001

Carvalho, P. H. R., da Hora Sales, P. H., da Rocha, S. S., Cavalcanti, A. M. M., de Jesus Rodrigues Mello, M., & Junior, J. M. S. M. (2019). Treatment of comminutive fractures by firearm projectiles with adapted wrist external fixator. Oral and Maxillofacial Surgery, 23(4), 501–505. https://doi.org/10.1007/s10006-019-00804-y

Cascone, P., Marra Marcozzi, M., Ramieri, V., Bosco, G., Vellone, V., & Spallaccia, F. (2017). Mandibular Condylar Fractures in Children: Morphofunctional Results After Treatment With External Fixation. Journal of Craniofacial Surgery, 28(7), 1742–1745. https://doi.org/10.1097/SCS.0000000000003914

Cascone, P., Spallaccia, F., Arangio, P., Vellone, V., & Gualtieri, M. (2017). A Modified External Fixator System in Treatment of Mandibular Condylar Fractures. Journal of Craniofacial Surgery, 28(5), 1230–1235. https://doi.org/10.1097/SCS.0000000000003669

Cornelius, C.-P., Augustin, J. B., & Sailer, L.-K. (2009). External pin fixation for stabilization of the mandible—comeback of a method: historical review and first experiences with the ‘mandible external fixator.’ Oral and Maxillofacial Surgery, 13(1), 1–14. https://doi.org/10.1007/s10006-008-0142-4

da Rocha, S. S., Sales, P. H. da H., Carvalho, P. H. R., Maia, R. N., Gondim, R. F., de Menezes Junior, J. M. S., & Mello, M. de J. R. (2021). Mandibular traumas by gunshot. A systematic review with meta-analysis and algorithm of treatment. British Journal of Oral and Maxillofacial Surgery, 59(3), e99–e108. https://doi.org/10.1016/j.bjoms.2020.08.019

Fernando, P. L. N., Abeygunawardane, A., Wijesinghe, P., Dharmaratne, P., & Silva, P. (2021). An engineering review of external fixators. Medical Engineering & Physics, 98, 91–103. https://doi.org/10.1016/j.medengphy.2021.11.002

Gibbons, A. J., Mackenzie, N., & Breederveld, R. S. (2011). Use of a custom designed external fixator system to treat ballistic injuries to the mandible. International Journal of Oral and Maxillofacial Surgery, 40(1), 103–105. https://doi.org/10.1016/j.ijom.2010.08.001

Kaufman, Y., Cole, P., & Hollier, L. H. (2009). Facial Gunshot Wounds: Trends in Management. Craniomaxillofacial Trauma & Reconstruction, 2(2), 85–90. https://doi.org/10.1055/s-0029-1202595

Kazi, A. A., Lee, T. S., Vincent, A., Sokoya, M., Sheen, D., & Ducic, Y. (2019). The Role of External Fixation in Trauma and Reconstruction of the Mandible in the Age of Rigid Fixation. Facial Plastic Surgery, 35(06), 614–622. https://doi.org/10.1055/s-0039-1700799

Kummoona, R. (2010). Management of Missiles Injuries of the Facial Skeleton. Journal of Craniofacial Surgery, 21(4), 976–981. https://doi.org/10.1097/SCS.0b013e3181e56e7e

Louvrier, A., Sigaux, N., Meyer, C., Benassarou, M., & Lutz, J. C. (2020). Customized three-dimensionally printed mandibular external fixator. International Journal of Oral and Maxillofacial Surgery, 49(11), 1445–1448. https://doi.org/10.1016/j.ijom.2020.02.012

Mahdian, N., Onderková, A., Brizman, E., Pavlíková, G., Vlachopulos, V., Drahoš, M., & Foltán, R. (2020). External fixation greatly improves outcomes in the surgical treatment of osteoradionecrosis of the jaws without affecting quality of life: a five-year retrospective study. British Journal of Oral and Maxillofacial Surgery, 58(9), e45–e50. https://doi.org/10.1016/j.bjoms.2020.05.031

Motamedi, M. H. K. (2003). Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries. Journal of Oral and Maxillofacial Surgery, 61(12), 1390–1398. https://doi.org/10.1016/j.joms.2003.07.001

Muddassar, M., Arshad, R., Rabbani, S., Qureshi, I. S., Khattak, I. K., & Rana, Z. (2020). Management of Gunshot Injuries of Mandible with Open Reduction and Internal Fixation versus Closed Reduction and Maxillo-mandibular Fixation. Cureus. https://doi.org/10.7759/cureus.7830

Rotbande, I., & Ramos MR. (2000). Atualização em fixação externa: conceitos e revisão. Rev Bras Ortop, 35(4).

Santini, A. (2019). Spotlight on How to Structure a Case Report. The Journal of Critical Care Medicine, 5(2), 76–79. https://doi.org/10.2478/jccm-2019-0007

Vural, E., & Yuen, J. C. (2007). Combining Use of Resin Models With External Fixation in Mandibular Reconstruction. Archives of Otolaryngology–Head & Neck Surgery, 133(6), 603. https://doi.org/10.1001/archotol.133.6.603

Wilkening, M. W., Patel, P. A., & Gordon, C. B. (2012). External Fixation in a Low-Velocity Gunshot Wound to the Mandible. Journal of Craniofacial Surgery, 23(5), e418–e419. https://doi.org/10.1097/SCS.0b013e31825daecc

Wojcik, T., Nicot, R., Ferri, J., & Raoul, G. (2016). A Cheap Hand-Made Mandibular External Fixator? Journal of Craniofacial Surgery, 27(7), 1839–1841. https://doi.org/10.1097/SCS.0000000000002963

Yin, X., Tan, Y., Liu, Y., Sun, W., Zhang, X., Hu, Y., Sun, J., Zhang, C., & Zhong, L. (2019). Clinical Application of Temporary External Fixator for Immediate Mandibular Reconstruction. Journal of Craniofacial Surgery, 30(4), e337–e342. https://doi.org/10.1097/SCS.0000000000005303

Downloads

Published

08/05/2024

How to Cite

FALCÃO, A. P. .; PASSOS, M. X. .; MATTOS, C. M. .; PRADO, G. A. S. .; GASPAR, V. F. .; DOMANESCHI, C. Wrist external fixator for treatment of comminuted mandible fracture caused by gunshot wound: A case report. Research, Society and Development, [S. l.], v. 13, n. 5, p. e2713545733, 2024. DOI: 10.33448/rsd-v13i5.45733. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/45733. Acesso em: 29 jun. 2024.

Issue

Section

Health Sciences