{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:08:20Z","timestamp":1791414500348,"version":"4.3.3"},"reference-count":51,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: War-related mandibular injuries result in extensive soft-tissue damage, severe comminution, and bone loss, and are associated with high rates of infection and delayed healing. No universally accepted management protocol exists for these injuries. External fixation is commonly used in this context, particularly when internal fixation is unavailable or contraindicated. This study aimed to analyze injury patterns, treatment outcomes, and complications of war-related mandibular fractures treated with external fixation as a primary and definitive stabilization method in a resource-limited setting in eastern Democratic Republic of Congo. Methods: A retrospective review was conducted of all patients who sustained war-related mandibular fractures and were treated with external fixation between January 2017 and December 2024 at the H\u00f4pital Provincial G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Bukavu. Demographic data, injury characteristics, treatment details, outcomes, and complications were collected. Factors associated with delayed union and fracture-related infection were evaluated using univariate analysis. Results: Ninety-one patients with severe mandibular war injuries were included. High-velocity gunshot wounds accounted for 94.5% of injuries. Clinical evidence of wound infection at admission was present in 29.7% of patients. The mean delay between injury and external fixation was 9.2 \u00b1 6.6 days. Successful bone healing without secondary bone procedures was achieved in 71 patients (78.0%), with a mean healing time of 7.6 \u00b1 3.0 weeks. Delayed bone grafting was required in 20 patients (22.0%), performed at a mean of 77.3 \u00b1 30.5 days after initial fixation. The overall complication rate was 36.3%, with fracture-site infection being the most frequent complication (30.8%). Bone loss at presentation, clinical infection at admission, and the need for bone grafting were significantly associated with fracture-related infection (p &lt; 0.05). Conclusions: War-related mandibular fractures in this series were characterized by severe comminution, bone loss, infection, and delayed presentation. Despite these challenges, external fixation provided acceptable fracture healing and functional outcomes. Small orthopedic external fixators represent a pragmatic and effective treatment option for complex mandibular war injuries in resource-limited settings.<\/jats:p>","DOI":"10.3390\/jcm15020736","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T09:28:12Z","timestamp":1768555692000},"page":"736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["External Fixation for War-Related Mandibular Fractures in a Resource-Limited Setting: A Retrospective Study of 91 Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0601-7089","authenticated-orcid":false,"given":"Franck Masumbuko","family":"Mukamba","sequence":"first","affiliation":[{"name":"Surgery Department, H\u00f4pital Provincial G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Bukavu, Universit\u00e9 Catholique de Bukavu, Bukavu 285, Congo"},{"name":"Oral and Maxillofacial Surgery Lab (OMFS Lab), Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Exp\u00e9rimentale et Clinique (IREC), Universit\u00e9 Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li\u00e9vin","family":"Muhindo","sequence":"additional","affiliation":[{"name":"Surgery Department, H\u00f4pital Provincial G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Bukavu, Universit\u00e9 Catholique de Bukavu, Bukavu 285, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-H\u00e9l\u00e8ne","family":"Bisimwa","sequence":"additional","affiliation":[{"name":"Surgery Department, H\u00f4pital Provincial G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Bukavu, Universit\u00e9 Catholique de Bukavu, Bukavu 285, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Budema","sequence":"additional","affiliation":[{"name":"Surgery Department, H\u00f4pital Provincial G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Bukavu, Universit\u00e9 Catholique de Bukavu, Bukavu 285, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Cikomola","sequence":"additional","affiliation":[{"name":"Surgery Department, H\u00f4pital Provincial G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Bukavu, Universit\u00e9 Catholique de Bukavu, Bukavu 285, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georges","family":"Kuyigwa","sequence":"additional","affiliation":[{"name":"Surgery Department, H\u00f4pital Provincial G\u00e9n\u00e9ral de R\u00e9f\u00e9rence de Bukavu, Universit\u00e9 Catholique de Bukavu, Bukavu 285, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3033-7408","authenticated-orcid":false,"given":"Olivier","family":"Cornu","sequence":"additional","affiliation":[{"name":"Division of Orthopedics and Musculoskeletal Trauma, Cliniques Universitaires Saint Luc, Universit\u00e9 Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium"},{"name":"Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Exp\u00e9rimentale et Clinique (IREC), Universit\u00e9 Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7674-1150","authenticated-orcid":false,"given":"Gregory","family":"Reychler","sequence":"additional","affiliation":[{"name":"Service de Kin\u00e9sith\u00e9rapie et Ergoth\u00e9rapie, Institut de Recherche Exp\u00e9rimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Universit\u00e9 Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5665-4340","authenticated-orcid":false,"given":"Herv\u00e9","family":"Reychler","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint Luc, Universit\u00e9 Catholique de Louvain, 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2211-7731","authenticated-orcid":false,"given":"Raphael","family":"Olszewski","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery Lab (OMFS Lab), Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Exp\u00e9rimentale et Clinique (IREC), Universit\u00e9 Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium"},{"name":"Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Exp\u00e9rimentale et Clinique (IREC), Universit\u00e9 Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium"},{"name":"Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint Luc, Universit\u00e9 Catholique de Louvain, 1200 Brussels, Belgium"},{"name":"Department of Perioperative Dentistry, L. Rydygiera Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1177\/019459989411100607","article-title":"Gunshot wounds to the mandible and midface: Evaluation, treatment, and avoidance of complications","volume":"111","author":"Cole","year":"1994","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.anplas.2019.07.005","article-title":"The outcome of pectoralis major myocutaneous flap in the reconstruction of large defects in the lower face region after high velocity gunshot injury in the eastern part of DR Congo","volume":"65","author":"Cikomola","year":"2020","journal-title":"Ann. Chir. Plast. 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