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Incarceration Status Significantly Impacts Surgical Management in Mandible Fractures
Jane McLarney
*, Rachel Lister, Anam J. Furrukh, Uma Agrawal, Courtney Heitmiller, Spoorthi Balu, Janice F. Lalikos
University of Massachusetts Medical School, Worcester, MA
Background: Mandible fractures are common in the U.S., often from assaults, motor vehicle crashes, and falls. Incarcerated individuals may face delayed care, increased violence, and more comorbidities. This study examines fracture patterns, treatment disparities, and incarceration's impact on outcomes.
Methods: A single-center retrospective review (2017-2024) compared incarcerated and non-incarcerated adult mandible fracture patients. Data on demographics, injuries, management, and outcomes were analyzed using Fisher's exact and T-tests (p < 0.05) in RStudio.
Results: Of 291 patients, 48 (19.75%) had a history of incarceration. Incarcerated patients were more likely to have assault-related injuries (OR = 3.34, p = 0.0002) and less likely to have non-assault trauma (OR = 0.30, p = 0.0002). While surgery was recommended at similar rates (80.2% vs. 88.7%, p = 0.172), fewer incarcerated patients received surgery (87.2% vs. 95.3%, p = 0.0408). Non-incarcerated patients were 2.94 times more likely to undergo surgery, though this was not statistically significant (OR = 0.34, p = 0.0516). Incarcerated patients were also nearly twice as likely to be lost to follow-up (OR = 1.89, p = 0.04236). Time to surgery and postoperative outcomes did not differ significantly between groups.
Conclusion: This study reveals disparities in mandible fracture care between incarcerated and non-incarcerated adults, including lower surgery rates, higher loss to follow-up, substance abuse, and more assault-related injuries. Incarceration status did not affect time to surgery or postoperative outcomes, highlighting the need for further research.
Figure 1: Association Between Incarceration Status and Clinical & Behavioral Outcomes This forest plot displays the odds ratios (OR) and 95% confidence intervals (CI) for variables significantly associated with incarceration status (p < 0.05). Incarcerated patients have higher odds of intravenous drug use, tobacco use, loss to follow-up, and assault-related injury, while they have lower odds of non-assault-related injury and receiving surgery. The reference line (OR = 1) indicates no association.
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