Oral and Maxillofacial Surgery

, Volume 23, Issue 4, pp 501–505 | Cite as

Treatment of comminutive fractures by firearm projectiles with adapted wrist external fixator

  • Paulo Henrique Rodrigues Carvalho
  • Pedro Henrique da Hora SalesEmail author
  • Suellen Sombra da Rocha
  • Alan Melke Moura Cavalcanti
  • Manoel de Jesus Rodrigues Mello
  • Jose Maria Sampaio Menezes Junior
Case Report



Facial and mandibular aggression with gunshot wound (GSW) is highly complex and represents a challenge for the assistant surgical team because in addition to the inherent lethal potential, they have the capacity for destruction and mutilation caused by the high kinetic energy conferred to the firearm projectile. Among these lesions, comminutive mandibular fractures are difficult to treat because the anatomical planes are distorted, soft tissues are in severe disarrangement, and bone fragments are without periosteum, which, if opted for an open treatment, with internal fixation, favor the development of soft tissue infections, osteomyelitis, and suture dehiscence. The treatment of comminuted mandibular fractures with external fixator, widely used during the Second World War, represents a modality of treatment that minimizes the risks of failure, since it allows stabilization of the fractured mandible with minimal aggression to the soft tissues.


The objective of this study is to report three cases where surgical procedures were performed to treat comminuted mandible fractures with the adaptation of specific external orthopedic fixator for wrist.


Fracture fixation Mandibular fractures External fixators 



The financial support was provided by the authors and there was not corporate involvement.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The patients in this study signed a free and informed consent form in which they authorize the publication of their images or photographs in any type of media with educational purpose, research, and dissemination of scientific knowledge.


  1. 1.
    Braidy HF, Ziccardi VB (2009) External fixation for mandible fractures. Atlas Oral Maxillofac Surg Clin 17(1):45–53CrossRefGoogle Scholar
  2. 2.
    Clark N, Birely B, Manson P, Slezak S, Kolk C, Robertson B et al (1996) High-Energy ballistic and avulsive facial injuries: classification, patterns, and an algorithm for primary reconstruction. Plast Reconstr Surg 98:583–601CrossRefGoogle Scholar
  3. 3.
    Baurmash H (2004) Closed reduction, an effective alternative for comminuted mandible fractures. J Oral Maxillofac Surg 62:115–116CrossRefGoogle Scholar
  4. 4.
    Gibbons A, Mackenzie N, Breederveld R (2011) Use of a custom designed external fixator system to treat ballistic injuries to the mandible. Int J Oral Maxillofac Surg 40:103–105CrossRefGoogle Scholar
  5. 5.
    Cornelius C, Augustin J, Sailer L (2008) External pin fixation for stabilization of the mandible—comeback of a method: historical review and first experiences with the ‘mandible external fixator’. Oral Maxillofac Surg 13:1–14CrossRefGoogle Scholar
  6. 6.
    Ribeiro ILH, Cerqueira LS, Dultra FK et al (2012) Treatment for fracture mandibular of firearm with external fixation: case report. R Ci Med Biol 11:341–345Google Scholar
  7. 7.
    Berryman HE (2019) A systematic approach to the interpretation of gunshot wound trauma to the cranium. Forensic Sci Int 301:306–317CrossRefGoogle Scholar
  8. 8.
    Peled M, Leiser Y, Emodi O, Krausz A (2011) Treatment protocol for high velocity/high energy gunshot injuries to the face. Craniomaxillofac Trauma Reconstr 05:31–40Google Scholar
  9. 9.
    Wessberg GA, Wolford LM (1982) Monophase extraskeletal fixation: principles for use in severe mandibular trauma. Int J Oral Surg 11(1):1–6CrossRefGoogle Scholar
  10. 10.
    Mowlem R et al (1941) External pin fixation for fractures of the mandible. Lancet 238(6162):391–393CrossRefGoogle Scholar
  11. 11.
    Alencar MGM, Bortoli MM, Silva TCGD, Silva EDOE, Laureano Filho JR (2018 Jun) Suitability of wrist external fixator for treatment of mandibular fracture. J Craniofac Surg 29(4):e371–e372CrossRefGoogle Scholar
  12. 12.
    Zorman D (1990) Treatment of mandibular fractures by external fixation. Oral Surg Oral Med Oral Pathol 69(1):15–19CrossRefGoogle Scholar
  13. 13.
    Ellis E, Muniz O, Anand K (2003) Treatment considerations for comminuted mandibular fractures. J Oral Maxillofac Surg 61(8):861–870CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Paulo Henrique Rodrigues Carvalho
    • 1
  • Pedro Henrique da Hora Sales
    • 2
    • 3
    Email author
  • Suellen Sombra da Rocha
    • 4
  • Alan Melke Moura Cavalcanti
    • 4
  • Manoel de Jesus Rodrigues Mello
    • 4
  • Jose Maria Sampaio Menezes Junior
    • 1
    • 4
  1. 1.Santa Casa de Misericórdia Hospital of FortalezFortalezaBrazil
  2. 2.Federal University of PernambucoRecifeBrazil
  3. 3.Federal University of Pernambuco, School of DentistryRecifeBrazil
  4. 4.Doc. José Frota InstituteFortalezaBrazil

Personalised recommendations