Early fixation of traumatic mandible fractures is associated with decreased morbidity and resource utilization

BACKGROUND: There is no clear guidance on when isolated mandibular fractures should undergo surgical fixation. Multiple studies have assessed the timing of mandibular fracture repair, with a consensus that earlier repair does not change outcomes. We aimed to challenge this consensus and identify a data-driven time for surgical fixation. We hypothesized that delayed fixation would be associated with worse outcomes. METHODS: Data on adult patients with closed mandible fractures who underwent surgical fixation were abstracted from the Trauma Quality Improvement Program database from 2017 to 2023. Patients with prehospital cardiac arrest, Abbreviated Injury Scale >2 in other body regions, interfacility transfers, deaths, and those discharged from the emergency room were excluded from analysis. The primary outcome was a composite variable of in-hospital complications. The secondary outcome was prolonged mechanical ventilation. A receiver operating characteristic curve was generated to determine a data-driven timing of surgical fixation based on observed differences in the primary outcome. Patients who underwent fixation before and after this defined time were grouped as “early” or “delayed,” respectively. Statistical analyses used to compare outcomes between the groups included multivariable logistic regression and negative binomial regression. RESULTS: Receiver operating characteristic analysis identified 40 hours as the proposed data-driven time to fixation. Delayed fixation was associated with a higher composite complication rate (4.1% vs. 1.5%, p < 0.001) and independently associated with a two-fold increase in overall complications (adjusted odds ratio, 2.31; 95% CI, 1.90–2.79, p < 0.001). The negative binomial generalized linear model also identified delayed fixation as a risk factor for prolonged mechanical ventilation (incidence rate ratio, 1.42; 95% CI, 1.26–1.61, p < 0.001). CONCLUSIONS: The proposed data-driven timing for fixation in traumatic mandibular fractures is within the first 40 hours from admission. Repair within this time frame is associated with fewer complications and shorter duration of mechanical ventilation. ( J Trauma Acute Care Surg . 2026;00: 000–000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.) LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.