Risk factors associated with short-term complications in mandibular fractures: the MANTRA study—a Maxillofacial Trainee Research Collaborative (MTReC)

Abstract Introduction Complications following mandibular fractures occur in 9–23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. Methods The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. Results Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. Discussion We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications. </jats:sec

Benchmarking the seismic assessment of unreinforced masonry buildings from a blind prediction test

This paper presents a benchmark exercise for the seismic assessment of unreinforced masonry (URM) buildings as a follow-up of a blind prediction test organized in the context of the European Conference of Earthquake Engineering Series. The blind prediction exercise was aimed at better defining the open issues in current procedures for modeling and performing seismic analysis of URM buildings, by highlighting the uncertainty that can influence the results. This work presents an overview of the approaches used by different research teams and the scope of predictions. The benchmark structure was a three-story building with traditional European architecture from which two Cases were considered: A) stone masonry walls and flexible horizontal diaphragms and B) brick masonry walls and rigid horizontal diaphragms. A wide range of approaches was used by the participating teams concerning modeling strategies, methods of analysis and criteria for the attainment of limit states, which are here addressed as potential sources for the dispersion of predictions. The results were compared in terms of capacity curves, predicted failure mechanisms compatible with the fulfillment of limit states of near collapse and damage limitation, and related minimum values of peak ground acceleration (PGA). The results show an overall good agreement for damage patterns and collapse mechanisms in both benchmark structures, presenting some differences in the type of failure mode and its extent. However, the scatter of predicted capacity curves and critical PGAs is very high, especially for the Case with brick masonry and rigid diaphragms, indicating that clearer procedures in the building codes are required for professionals