Open Versus Closed Management for Gunshot Wounds of the Mandible - Which More Frequently Achieves Satisfactory Bony Union? A Systematic Review and Meta-Analysis
Abstract
PURPOSE
Closed management of high-energy mandibular injuries has been considered the gold standard for many years, but open management is preferable for its shorter overall treatment time. At present, there is a paucity of evidence on which to base management decisions, and as such there is a priority to review the literature to define the optimal treatment for mandibular gunshot wounds (GSWs).
METHOD
The study design was a systematic review with meta-analyses and the protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Electronic searches of published literature in the MEDLINE and Embase databases (1980-present) were conducted. Search terms included "gunshot", "firearm", "mandible", and "jaw". Inclusion criteria were randomized controlled trials (RCTs), cohort studies, case-control studies, and case series written in English describing studies involving patients with mandibular fractures caused by GSWs [population] containing information on treatment by either open reduction and (nonwire) internal fixation [intervention] or by closed reduction ± external fixation [comparator], and the frequency of bony union and complications [outcomes]. Meta-analysis was conducted using the Mantel-Haenszel odds ratio (OR) as the measure of effect. The quality of evidence was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies.
RESULTS
159 studies were…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 190 participants or records.
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