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Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm.

Publication ,  Journal Article
Cahill, TJ; Gandhi, R; Allori, AC; Marcus, JR; Powers, D; Erdmann, D; Hollenbeck, ST; Levinson, H
Published in: Ann Plast Surg
November 2015

BACKGROUND: Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised. MATERIALS AND METHODS: A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article's reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis. RESULT: Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases, there was no report as to hardware management. Finally, our review revealed that there were no reported differences in outcomes between groups. CONCLUSIONS: Management of CMF hardware infections should be performed in a sequential and consistent manner to optimize outcome. An evidence-based algorithm for management of CMF hardware infections based on this critical review of the literature is presented and discussed.

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Published In

Ann Plast Surg

DOI

EISSN

1536-3708

Publication Date

November 2015

Volume

75

Issue

5

Start / End Page

572 / 578

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Skull Fractures
  • Maxillofacial Injuries
  • Maxillary Fractures
  • Internal Fixators
  • Humans
  • Fracture Fixation, Internal
  • Device Removal
  • Decision Support Techniques
 

Citation

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Cahill, T. J., Gandhi, R., Allori, A. C., Marcus, J. R., Powers, D., Erdmann, D., … Levinson, H. (2015). Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm. Ann Plast Surg, 75(5), 572–578. https://doi.org/10.1097/SAP.0000000000000194
Cahill, Thomas J., Rikesh Gandhi, Alexander C. Allori, Jeffrey R. Marcus, David Powers, Detlev Erdmann, Scott T. Hollenbeck, and Howard Levinson. “Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm.Ann Plast Surg 75, no. 5 (November 2015): 572–78. https://doi.org/10.1097/SAP.0000000000000194.
Cahill TJ, Gandhi R, Allori AC, Marcus JR, Powers D, Erdmann D, et al. Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm. Ann Plast Surg. 2015 Nov;75(5):572–8.
Cahill, Thomas J., et al. “Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm.Ann Plast Surg, vol. 75, no. 5, Nov. 2015, pp. 572–78. Pubmed, doi:10.1097/SAP.0000000000000194.
Cahill TJ, Gandhi R, Allori AC, Marcus JR, Powers D, Erdmann D, Hollenbeck ST, Levinson H. Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm. Ann Plast Surg. 2015 Nov;75(5):572–578.

Published In

Ann Plast Surg

DOI

EISSN

1536-3708

Publication Date

November 2015

Volume

75

Issue

5

Start / End Page

572 / 578

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Skull Fractures
  • Maxillofacial Injuries
  • Maxillary Fractures
  • Internal Fixators
  • Humans
  • Fracture Fixation, Internal
  • Device Removal
  • Decision Support Techniques