DELAYED UNION OF MANDIBULAR FRACTURES: ANALYSIS OF 74 CLINICAL CASES

Abstract

Delayed union of bone tissue in patients with mandibular fractures is observed in 2.4 – 26 % of clinical cases. Solution of this problem yet very much far from the final solutio and there is an urgent requirement in the comprehensive analysis of role of general and local factors of origin of delayed union MF. Methods. Modern clinical, laboratory and microbiological research methods were used in the work. Densitometry conducted on computed tomograph Planmeca Promax 3d (Finland) (85 kV 5–7 mA). The basal values of immunoglobulins of the main classes and interleukins IL-1β, FNT-α, IL-4, MDA, SOD and catalase activity, POL, β-Cross Laps and osteocalcin in peripheral blood were determined in 74 patients with delayed consolidation of the mandibular fractures. Correlation analysis of local and general (concomitant somatic pathology) factors, and clinic-laboratorial parameters in patients with delayed consolidation of the mandibular fractures is conducted. Results. There is a high correlation between β-Cross Laps (negative) and osteocalcin (positive) and bone mineral density. The mean inverse correlation relationship was established between the MDA and catalase activity and BMD (r=–0.57), and the high correlation of these indices with markers of bone remodeling (positive to β-Cross Laps (r=0.80 and r=0.87, respectively) and negative to osteocalcin (r=–0.80 and r=–0.84, respectively). High direct correlation between FNT-α indices and POL, MDA, and catalase indices, as well as very strong with β-Cross Laps (positive) and osteocalcin (negative), and also with high-correlation ligaments of sIgA and IL-1β. Discussion. Convincing clinical and laboratory data were obtained that the combined effect of local and general (concomitant somatic pathology) factors on the basis of the activation of inflammation processes, which increase the indirect influence on immune factors, processes of radical oxidation and bone metabolism, is resulted to delayed union. It was also found that clinical signs of the development of consolidation complications in patients with MF include increased signs of inflammation (oedema, exudation, etc.) up to the 3rd day and preservation of even moderate signs of inflammation (inflation, local hyperemia, and others) after the 7th day, BMD below 600 HU. Among the local factors that increase the infectious risk and inflammatory reaction, the following clinical situations should be distinguished: comminuted fracture; the presence of a tooth in the line of fractures; partially edentulous with loss of antagonist teeth (according to Eichner); complete adentia with mandible atrophy.