Cranial Maxillofac Trauma Reconstruction 2019; 12(02): 128-133
DOI: 10.1055/s-0038-1639351
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Hybrid Arch Bar Is a Cost-Beneficial Alternative in the Open Treatment of Mandibular Fractures

Renata Khelemsky
1  Division of Oral & Maxillofacial Surgery, Mount Sinai Beth Israel Hospital, New York, New York
,
David Powers
2  Division of Plastic, Reconstructive, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
,
Seth Greenberg
1  Division of Oral & Maxillofacial Surgery, Mount Sinai Beth Israel Hospital, New York, New York
,
Visakha Suresh
3  Duke University School of Medicine, Durham, North Carolina
,
Ellen Johnson Silver
4  Department of Pediatrics, Mount Sinai Beth Israel Hospital, New York, New York
,
Michael Turner
1  Division of Oral & Maxillofacial Surgery, Mount Sinai Beth Israel Hospital, New York, New York
› Author Affiliations
Further Information

Publication History

16 November 2017

02 February 2017

Publication Date:
12 April 2018 (eFirst)

Abstract

Obtaining maxillomandibular fixation (MMF) to achieve fracture reduction and functional occlusion is essential in the management of maxillofacial trauma. The aims of this retrospective review were to compare the total time spent in the operating room (OR) when using the Erich arch bar (EAB) versus the bone anchored hybrid arch bar (HAB) as well as performing a cost–benefit analysis (CBA). The study sample comprised patients older than 18 years who underwent open reduction internal fixation of mandible fractures at two separate institutions over a 5-year period. The primary outcome variable was total surgical time in minutes, defined as the time from incision to the completion of closure. Average operative time was significantly longer for the EAB than for the HAB (186.74 ± 70.73 vs. 135.98 ± 2.69 minutes, p < 0.001). A significant amount of time was saved by using the HAB for unilateral (37.17 ± 13.19 minutes; p = 0.007) and bilateral fractures (55.83 ± 18.89 minutes; p = 0.005). In-depth CBA showed that, for average OR fees of $60 per minute, the HAB produced savings of at least 4.01 and 11.63% of the total cost of surgery for unilateral and bilateral fractures. These results support the hypothesis that the HAB is a time-saving maneuver in the open treatment of mandible fractures. The HAB saves more time in bilateral fracture cases despite the longer overall operative times. This study shows the differential time-saving effect of the HAB regardless of fracture laterality as well as its cost minimization benefit compared with the EAB.