More commonly, open reduction and rigid internal fixation is placed.When the width of the mandible is less than 1 cm, the jaw loses its endosteal blood supply. Instead, the blood supply comes largely from the periosteum. Open reduction (which normally strips the periosteum during the dissection) can lead to avascular necrosis. In these cases, oral surgeons sometimes opt for external fixation, closed reduction, supraperiosteal dissection or other techniques to maintain the periosteal blood flow. High velocity injuries
In high velocity injuries, the soft tissue can be severely damaged far from the bullet wound itself due to hydrostatic shock. Because of this the airway must be carefully managed and vessels well examined. Because the jaw can be highly comminuted, MMF and rigid internal fixation can be difficult. Instead, external fixation is often used,. Pathologic fracture
Fractures where large cysts or tumours are in the area (and weaken the jaw), where there is an area of osteomyelitis or where osteonecrosis exist cause special challenges to fixation and healing. Cysts and tumours can limit effective bone to bone contact and osteomyelitis or osteonecrosis compromise blood supply to the bone. In all of the situations, healing will be delayed and sometimes, resection is the only alternative to treatment. Prognosis
The healing time for a routine mandible fractures is 4–6 weeks whether MMF or rigid internal fixation (RIF) is used.
This is an uncommon cause in general, but is commonly seen in victims of nuclear disaster.Cases of psychogenic purpura are also described in the medical literature, some claimed to be due to "autoerythrocyte sensitization". Other studies suggest the local (cutaneous) activity of tissue plasminogen activator can be increased in psychogenic purpura, leading to substantial amounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding. Petechial rash is also characteristic of a rickettsial infection. Etymology and pronunciation
The word purpura () comes from Latin purpura, "purple", which came from ancient Greek πορφύρα. Purpura is a mass noun naming the condition or state, not the name of an individual spot (thus there is no *pupurum, *purpura or *purpura, *purpurae count declension). See also
Bruise, which is a hematoma caused by trauma
Petechia, which is a small type of hematoma (<3 mm)
Ecchymosis, which is a large type of hematoma (>1 cm)
Purpura secondary to clotting disorders
Purpura hemorrhagica in horses
Pigmented purpuric dermatosis
Schamberg disease (progressive pigmentary purpura)

References
External links

Evaluating the Child with Purpura from American Academy of Family Physicians