E-Scooter–Related Maxillofacial Fractures: A New Emerging Epidemic During the COVID-19 Period in the Province of Rome, Lazio, Italy: A Monocentric Study Review of 843 Patients Compared With the Pre-COVID-19 Two-Year Period

Abstract

Introduction: Shared vehicles, such as e-scooters and electric bicycles, could potentially accelerate the transition toward sustainable mobility. Focusing on e-scooters, the aim of this study is to show, compared with previous years when e-scooter use was significantly reduced, the increased incidence of maxillofacial bone injuries from e-scooters and the most frequent type of fractures. Methods: We conducted a monocentric observational retrospective and prospective analysis during the pandemic, from January 1, 2020, until December 31, 2022, on patients’ access for maxillofacial traumas at the San Giovanni Addolorata emergency department, trauma hub center, for Lazio district. A total of 383 patients were included. Data on the causes of traumas, type of injury produced, age, gender, nationality, and helmet use were collected. Especially, we analyzed the e-scooter–related facial traumas that had gained a lot of popularity in this period due to the restriction in mobility because of Covid-19, subsequent reduced use of public transport, and the new benefits introduced by the government for e-scooters or bikes. We compared e-scooter facial trauma with all the other kinds of facial fracture etiologies during this period. Results: In our study, the most frequent causes of trauma were assaults (32.6%), accidental falls (24.2%), and sports activities (7.8%). The percentage of trauma among road traffic injuries was almost 24% of the total; in particular, motorcycle/e-scooter traumas was 7.1%, car crashes was 5.5%, pedestrian hits was 4.2%, and bike accidents was 3.1%. Other causes detected were syncope (5.5%), accidental traumas (1.8%), and epileptic crisis (1.1%). Focusing on road traffic injury access in our emergency department, compared with those between 2017 and 2019, it emerged that e-scooter–related facial traumas in the past two years have had a remarkable rise. In fact, there was a total of 27 patients (52% male and 48% female) instead of 5 between 2017 and 2019. The average age was 29 years. The most frequent types of e-scooter–related fractures were those to the nasal bones (29.7%), followed by mandibular fractures (unifocal 7.4%, bifocal 18.5%, trifocal 7.4%, and condylar 7.4%), zygomatic-maxillo fractures (18.4%), complex fractures (7.4%), and maxilla (3.7%). Among 27 observed electric scooter riders, nobody wore a helmet. Conclusions: Injuries associated with the use of e-scooters are a new phenomenon and mainly affect the craniofacial region due to the dynamic nature of the trauma. Although these vehicles have become increasingly common over the years and accepted within regulatory frameworks, the traffic rules are not ready to integrate e-scooters into the transport systems due to the lack of adequate legislation, and the lack of implementation in the form of facial safety devices or safety skills training for e-scooter riders.

Dynamic Trends in Surgical Oromaxillofacial Trauma Epidemiology: A Comparative Study of Pre-COVID-19 and COVID-19 Periods in Tertiary Referral Hospitals in Madrid

“…In the postpandemic period, various studies have found that health professionals reduced their protective measures [38] due to burnout or psychological reasons, among others. The most recently published articles that studied the influence of COVID-19 on the epidemiology of maxillofacial fractures concluded that the COVID-19 pandemic has produced a change in the epidemiology of oromaxillofacial fractures [43][44][45][46][47][48][49], but the differences observed are specific in each study because the etiology is very diverse and characteristic of the different countries and regions studied. New etiologies have been described, such as the use of electric scooters [50,51], which are producing changes in modes of transportation within cities and even regulatory changes promoting the use of protection measures [52].…”

A Comparison of the Specific Facial Trauma Cases at the Department of Maxillofacial Surgery, Gdansk, Poland, from March 2019 to August 2023

“…We did not take polytrauma into account. With the introduction of e-scooters in Rome, Lazio, Italy, the most recorded fractures were those to the nasal bones, mandibular fractures, zygomaticomaxillary fractures, complex fractures, and maxilla [ 15 ]. The findings regarding injuries affecting the mandible or maxilla were consistent with our research.…”