Safely Repairing Facial Fractures in the Battlefield

Soldiers who sustain a facial fracture can safely and definitively undergo repaired open reduction and internal fixation (ORIF) in the war zone.

Researchers at the Wilford Hall Medical Center (Lackland Air Force Base, San Antonio, TX, USA) reviewed a total of 207 patients who underwent 388 facial plastic procedures at a theater hospital located at Balad Air Base (Iraq) between May and September 2005. The criteria used to determine candidacy for definitive in-theater facial fracture repair on American military personnel were that the fracture site was exposed through either a soft tissue wound or because of an adjacent surgical approach; that treatment would not delay evacuation from the theater; and that treatment would allow the military member to remain in theater.

The results showed that in 175 of these patients, the operation was performed for a traumatic injury, including 52 patients who underwent ORIF of a facial fracture. Seventeen of the 52 ORIF-treated patients were American military personnel; of these, 16 were available for follow-up. During the follow-up period, none of these patients developed an Acinetobacter baumannii infection or had a complication caused by the definitive in-theater ORIF. The range of follow-up was two to 11 months (mean 8.3 months). The study was published in the November/December 2007 edition of the Archives of Facial Plastic Surgery.

"Although it was initially appropriate to delay the definitive surgical repair of facial fractures until the wounded were air evacuated out of theater, it has now been shown that delaying treatment is no longer warranted,” said study authors Dr. Manuel A. Lopez, M.D., and Dr. Jonathan L. Arnholt, M.D. "Definitive treatment of facial fractures with ORIF in American soldiers is advised when the aforementioned criteria are applied.”

Prior to May 2005, most patients with a facial fracture were air evacuated to a center away from the theater of war for definitive treatment. This was largely due to concerns about sterility and infection with A. baumannii, a species of a pleomorphic aerobic gram-negative bacillus, which forms opportunistic infections. There have been many reports of multi-drug resistant Acinetobacter baumannii (MDRAB) infections among American soldiers wounded in Iraq.


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Wilford Hall Medical Center