Evaluation of delayed versus immediate bone reduction with rigid internal fixation for high-velocity ballistic maxillofacial injuries with severely comminuted fractures

Background: High-velocity ballistic maxillofacial injuries cause extensive bone comminution and soft-tissue destruction. Determining the optimal timing of definitive fixation remains controversial, especially in contaminated wounds. To compare infection rate, bone-healing complications, and functional recovery between immediate and delayed bone reduction with rigid internal fixation in severely comminuted ballistic maxillofacial injuries. Methods: A retrospective cohort study of 90 patients treated between 2011 and 2013 at Tishreen Military Hospital, Damascus, Syria was conducted. Group A (n=32) received immediate fixation (< 24 h); Group B (n=58) underwent delayed fixation (7–21 days) after staged debridement and stabilization. Outcomes included infection, non-union/malunion, and six-month functional success. Analyses used chi-square tests, absolute-risk reduction (ARR), and number-needed-to-treat (NNT). Results: Delayed fixation reduced infection (10% vs 41%), non-union/malunion (8% vs 35%), and improved function (93% vs 60%). ARR values were 31%, 27%, and 33%, respectively. Conclusions: In severely comminuted high-velocity ballistic facial injuries, delayed rigid fixation following thorough debridement yields fewer complications and better functional outcomes than immediate fixation.