American Association of Plastic Surgeons

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Mandible Fractures Undergoing Transfer Rarely Require Acute Intervention
Charles C. Jehle, Jr., M.D., Sun Hsieh, M.D., Marten N. Basta, M.D., Vinay Rao, M.D., Damon McIntire, B.A., Albert S. Woo, M.D..
Brown University at Rhode Island Hospital, Providence, RI, USA.

PURPOSE:
Patients with mandible fractures are transferred to a tertiary care center specifically for a specialist evaluation. Acute intervention is rarely indicated in these cases. We examined the frequency of transfers for mandible fractures compared to the rate of acute intervention by plastic surgery.METHODS:A retrospective review of patients with isolated mandible fractures between 1/1/2017-10/1/2017 was conducted. Location of injury, transfer status, discharge date, date of surgery if performed, and acute interventions were reviewed. RESULTS: 66 patients sustained isolated mandible fractures. The average age was 36.6 years and 67% were male. Injury was most commonly assault (48%), then fall (33%), then vehicular trauma (12%) and other (5%). 27% had documented open fractures while 52% sustained fracture of a tooth bearing segment of the mandible. 32 (48.4%) were transferred from an outside hospital. Only 2 (6.3%) patients who were transferred were admitted underwent surgical repair of the fracture during the hospitalization. Overall 43 (65.2%) patients ultimately underwent surgical intervention at our hospital, presenting after discharge for scheduled surgery an average of 8 +/- 5.6 days after presentation. CONCLUSION:
At our hospital the majority of patients presenting to the ED with mandible fracture were transferred and discharged without acute intervention. The cost to our healthcare system for an overtriaged patient was published in the Journal of Trauma to be over $5,900 in 2010. These transfers strain our healthcare system without obvious advantage to the patient. A system providing safe discharge and specialist follow could decreases waste of resources and improve patient care.


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