Introduction: Facial fractures (FFs) occur after high-and low-energy trauma; differences in associated injuries and outcomes have not been well articulated. Objective: To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms. Methods: We conducted a 6-year retrospective local trauma registry analysis of adults aged 18-55 years old that suffered a FF treated at the Santa Barbara Cottage Hospital. Fracture patterns, concomitant injuries, procedures, and outcomes were compared between patients that suffered a high-energy mechanism (HEM: motor vehicle crash, bicycle crash, auto versus pedestrian, falls from height > 20 feet) and those that suffered a low-energy mechanism (LEM: assault, ground-level falls) of injury. Results: FFs occurred in 123 patients, 25 from an HEM and 98 from an LEM. Rates of Le Fort (HEM 12% vs. LEM 3%, P = 0.10), mandible (HEM 20% vs. LEM 38%, P = 0.11), midface (HEM 84% vs. LEM 67%, P = 0.14), and upper face (HEM 24% vs. LEM 13%, P = 0.217) fractures did not significantly differ between the HEM and LEM groups, nor did facial operative rates (HEM 28% vs. LEM 40%, P = 0.36). FFs after an HEM event were associated with increased Injury Severity Scores (HEM 16.8 vs. LEM 7.5, P <0.001), ICU admittance (HEM 60% vs. LEM 13.3%, P <0.001), intracranial hemorrhage (ICH) (HEM 52% vs. LEM 15%, P <0.001), cervical spine fractures (HEM 12% vs. LEM 0%, P = 0.008), truncal/lower extremity injuries (HEM 60% vs. LEM 6%, P <0.001), neurosurgical procedures for the management of ICH (HEM 54% vs. LEM 36%, P = 0.003), and decreased Glasgow Coma Score on arrival (HEM 11.7 vs. LEM 14.2, P <0.001). Conclusion: FFs after HEM events were associated with severe and multifocal injuries. FFs after LEM events were associated with ICH, concussions, and cervical spine fractures. Mechanism-based screening strategies will allow for the appropriate detection and management of injuries that occur concomitant to FFs. Type of study: Retrospective cohort study. Level of evidence: Level III.

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Ground-level falls (GLFs) are a frequent source of injury in the geriatric population. Facial fractures (FFs) are one subsequent injury that can occur and may be an important marker of functional decline. We conducted a retrospective analysis over a 6-year period of patients 65 years and older sustaining one or more FFs due to a GLF (n = 28). Demographics, comorbidities, FF patterns, concomitant injuries, procedures, and outcomes were analyzed. The mean age was 80.0 ± 8.2 years, 64% were male, 12 patients (43%) were on oral anticoagulants prior to injury, and mean injury severity score was 8.3 ± 7.0. Five patients (18%) had LeFort fractures (1 with LeFort I, 4 with LeFort II), and 5 (18%) had isolated mandible fractures (2 were bilateral). Nearly half of all patients suffered neurological injury (concussion: 18%, intracranial hemorrhage: 29%). Average hospital length of stay (LOS) was 4.0 ± 2.9 days. Eight patients (29%) required intensive care unit (ICU) admission with an average ICU-LOS of 2.8 ± 1.2 days. Surgical management was required in 4 patients (14%). More than half of the patients returned home (54%), 25% were discharged to a skilled nursing facility, 4% to rehabilitation, 7% to hospice, and 7% expired. Nearly one-third of patients required discharge to a higher level of care facility than their location prior to injury. GLF-induced FFs are often associated with significant injuries and serve as an indicator of functional decline. These injuries warrant trauma center admission for comprehensive evaluation and management.

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78) mmHg/h. Significantly decreased levels were found at 3 months for S100A12 (p<0.01), at 3 months for CRP (p<0.01) and at 1 and 3 months (p<0.01) for ESR (figure). Compared with the conventional inflammatory markers CRP and ESR, the neutrophil protein S100A12 had the highest correlations with the comprehensive BM and PD sum scores during the 12 months follow-up, (median (range) coefficients of 0.55 (0.35-0.78) for sum score BM and 0.45 (0.27-0.75) for sum score PD). Image/graph: Conclusions: S100A12 was found closer associated to the comprehensive US examinations than conventional inflammatory markers. The US scores reflect the degree of synovitis in RA patients during biologic treatment, and thus the present finding of high associations between US pathology and S100A12 shows that S100A12 is a promising serum biomarker for RA patients.