{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T16:23:07Z","timestamp":1780330987895,"version":"3.54.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"9-10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Facial fractures sustained in combat are generally unrepresentative of those commonly experienced in civilian practice. In the US military, acute trauma patient care is guided by the Joint Trauma System Clinical Practice Guidelines but currently none exists for facial trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and methods<\/jats:title>\n                  <jats:p>All casualties that underwent surgery to facial fractures between January 01, 2016 and September 15, 2019 at a US deployed Military Treatment Facility in Afghanistan were identified using the operating room database. Surgical operative records and outpatient records for local Afghan nationals returning for follow-up were reviewed to determine outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>55 casualties underwent treatment of facial fractures; these were predominantly from explosive devices (27\/55, 49%). About 46\/55 (84%) were local nationals, of which 32 (70%) were followed up. Length of follow-up ranged between 1 and 25\u00a0months. About 36\/93 (39%) of all planned procedures developed complications, with the highest being from ORIF mandible (18\/23, 78%). About 8\/23 (35%) casualties undergoing ORIF mandible developed osteomyelitis, of which 5 developed nonunion. Complications were equally likely to occur in those procedures for \u201cbattlefield type\u201d events such as explosive devices and gunshot wounds (31\/68, 46%) as those from \u201ccivilian type\u201d events such as falls or motor vehicle collisions (5\/11, 45%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Complications Rates from facial fractures were higher than that reported in civilian trauma. This likely reflects factors such as energy deposition, bacterial load, and time to treatment. Load sharing osteosynthesis should be the default modality for fracture fixation. External fixation should be considered in particular for complex high-energy or infected mandible fractures where follow-up is possible.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa159","type":"journal-article","created":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T05:50:39Z","timestamp":1596606639000},"page":"414-416","source":"Crossref","is-referenced-by-count":12,"title":["Combat Facial Fractures Sustained During Operation Resolute Support and Operation Freedom\u2019s Sentinel in Afghanistan"],"prefix":"10.1093","volume":"185","author":[{"given":"John","family":"Breeze","sequence":"first","affiliation":[{"name":"Royal Centre for Defence Medicine, University Hospitals Birmingham, Birmingham, B15 2TH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Gensheimer","sequence":"additional","affiliation":[{"name":"Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland 20762"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J","family":"DuBose","sequence":"additional","affiliation":[{"name":"Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, 22 S. 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