Mechanical falls are a common cause of facial trauma in the elderly population. It has been shown that the likelihood of sustaining a facial fracture due to a fall or activities of daily life significantly increases with age. Craniomaxillofacial fractures are most common during the first three decades of life; however, elderly patients more frequently require lengthy hospital stays and surgical intervention, and have shown increased complication rates compared with younger patients. The objective of this study was to examine the prevalence of facial fractures secondary to mechanical falls in the elderly population to analyze mechanism of injury, comorbidities, and fracture management. A retrospective review of all facial fractures as a result of falls in the elderly population in a level 1 trauma center in an urban environment was performed for the years 2002 to 2012. Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. During the time period examined, 139 patients were identified as greater than 60 years of age and having sustained a fracture of the facial skeleton as the result of a fall. The average age was 75.7 (range, 60–103) years, with no gender predominance of 50.4% female and 49.6% male. There were a total of 205 fractures recorded. The most common fractures were those of the orbit (42.0%), nasal bone (23.4%), zygoma (13.2%), and zygomaticomaxillary complex (7.32%). The average Glasgow Coma Scale on arrival was 12.8 (range, 3–15). Uncontrolled hemorrhage was noted on presentation to the trauma bay in five patients. Twenty-one patients were intubated on, or prior to, arrival to the trauma bay, and 44 required a surgical airway. The most common concomitant injury was a long bone fracture (23.5%), followed by cervical spine fracture (18.5%), skull fracture (17.3%), intracerebral hemorrhage (17.3%), rib fracture (17.3%), ophthalmologic injuries (6.2%), short bone fracture (4.9%), pelvic fracture (2.9%), thoracic spine fracture (1.2%), and lumbar spine fracture (1.2%). Of the 114 patients admitted to the hospital, 53 were admitted to an intensive care setting. The average hospital length of stay was 8.97 days (range, 0–125). Sixteen patients expired. Surgical management of fractures in the operating room was required in 47 of the 139 patients. Of the patients treated, 36.2% required an open reduction and internal fixation procedure. Facial fractures as a result of falls in the geriatric population represent an increasing number of cases in clinical practice as life expectancy steadily rises. These patients require a specific standard of treatment since they are more susceptible to nosocomial infections, as well as have higher complication rates and longer recovery time. Concomitant injuries such as cervical spine and pelvic fractures can greatly increase risk of mortality. Surgical and soft tissue management must be approached with caution to optimize function and aesthetics while preventing secondary infection. The authors hope that this study can provide some insight and further investigation as there is a dearth of literature to the management of facial fractures in falls in elderly patients.
Maxillofacial injury represents a significant number of emergency room visits worldwide.1-4 Several studies have examined the trends and demographics associated with patients sustaining facial fractures. 2,3,5,6 The mechanism of injury, age, and sex distribution, and the types of bones cited as most commonly fractured have been shown to vary by region. 4,6-8Etiologies typically reported as most common are often motor vehicle accidents (MVA) or interpersonal violence. 3,9Males have been observed to sustain facial fractures more often than women, and the mechanism of injury often varies between the sexes. 5,6 In most studies, the nasal bones, mandible, orbit, and zygoma are cited as the most commonly fractured bones of the facial skeleton. The purpose of this paper is to examine the demographic characteristics, Keywords► facial fractures ► facial trauma ► urban trauma center ► assault cases ► motor vehicle accidents AbstractThe etiology of fractures of the maxillofacial skeleton varies among studies, with motor vehicle accidents and assaults oftentimes the most common. The number of males outnumbers females throughout most studies. Fractures of the zygoma, orbit, and mandible are usually cited as most common fracture types. This study examines a single center's experience with regards to etiology and distribution of fractures. A retrospective review of all radiologically confirmed facial fractures in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patient demographics, etiology of injury, and location of fractures were collected. During this time period, 2,998 patients were identified as having sustained a fracture of the facial skeleton. The average age was 36.9 years, with a strong male predominance (81.5%). The most common etiologies of injury were assault (44.9%) and motor vehicle accidents (14.9%). Throughout the study period, the number of fractures as a result of assault remained relatively constant, whereas the number as a result of motor vehicle accidents decreased slightly. The most common fracture observed was of the orbit, followed by mandible, nasal bones, zygoma, and frontal sinus. Patients sustaining a fracture as a result of assault were more likely to have a mandible fracture. Patients in motor vehicle accidents were more likely to suffer fractures of the maxilla, orbit, and frontal sinus. Mandible fractures are more common in cases of assault. Motor vehicle accidents convey a large force, which, when directed at the craniofacial skeleton, can cause a variety of fracture patterns. The decreasing number of fractures as a result of motor vehicle accidents may represent improved safety devices such as airbags.
Background: The purpose of this study was to examine a level 1 trauma center's 12-year experience treating frontal sinus fractures with regards to patient demographics, management strategies, and treatment outcomes. Methods: An institutional review board-approved retrospective review of all facial fractures at a level 1 trauma center was performed for the years 2000 to 2012. Patient demographics, location of fractures, concomitant injuries, use of antibiotics, surgical management strategies and outcomes were collected for all frontal sinus fractures. A significance value of 5% was used. Results: There were 291 frontal sinus fractures treated at our institution. The mean age of patients was 34.4 years with a male predominance (90%). The most common mechanisms of injury were assault in 82 (28.2%) and motor vehicle accidents in 80 (27.5%). Anterior table fractures were seen in 261 patients (89.7%) and posterior table fractures were seen in 181 (62.2%). Treatment included ORIF with sinus preservation in 18 (6.2%), ORIF with sinus obliteration in 20 (6.9%), and cranialization in 18 (6.2%). Antibiotics were started on admission in 152 patients (52.2%). Fatality occurred in 9.3% of patients and complications included meningitis (1%), frontal sinusitis (1%), early wound infection (0.3%), and mucopyelocele (0.3%). Conclusions: Frontal sinus fractures in our center are most often caused by interpersonal violence. Anterior table fractures were more common than posterior table fractures and ORIF with sinus obliteration was the most common surgical intervention. Most frontal sinus fractures at our institution (82%) were treated conservatively with no surgical intervention and we observed a low rate of long term complications.
Objective Sports-related injuries, such as facial fractures, are potentially debilitating and may lead to long-term functional and aesthetic deficits in a pediatric patient. In this study, we analyze sports-related facial fractures in the urban pediatric population in an effort to characterize patterns of injury and improve management strategies and outcomes. Methods Retrospective chart review was performed for all facial fractures resulting from sports injuries in the pediatric population at a level-1 trauma center (University Hospital, Newark, NJ). Results Seventeen pediatric patients were identified as having sustained a fracture of the facial skeleton due to sports injury. Mean age was 13.9 years old. A total of 29 fractures were identified. Most common fracture sites included the orbit (n = 12), mandible (n = 5), nasal bone (n = 5), and zygomaticomaxillary complex (n = 3). The most common concomitant injuries included skull fracture (n = 3), intracranial hemorrhage (n = 4), and traumatic brain injury (n = 4). One patient was intubated upon arrival to the emergency department. Hospital admission was required in 13 patients, 4 of which were admitted to an intensive care setting. Nine patients required operative intervention. Mean length of hospital stay was 2.4 days. No patients were expired. Conclusions Sports-related facial fractures are potentially debilitating injuries in the pediatric population. Analysis of fracture pattern and concomitant injuries is imperative to develop effective management strategies and prevention techniques.
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