Impact of Injury Mechanisms on Patterns and Management of Facial Fractures

Abstract

Mechanisms causing facial fractures have evolved over time and may be predictive of the types of injuries sustained. The objective of this study is to examine the impact of mechanisms of injury on the type and management of facial fractures at our Level 1 Trauma Center. The authors performed an Institutional Review Board-approved review of our network's trauma registry from 2006 to 2010, documenting age, sex, mechanism, Injury Severity Score, Glasgow Coma Scale, facial fracture patterns (nasal, maxillary/malar, orbital, mandible), and reconstructions. Mechanism rates were compared using a Pearson χ2 test. The database identified 23,318 patients, including 1686 patients with facial fractures and a subset of 1505 patients sustaining 2094 fractures by motor vehicle collision (MVC), fall, or assault. Nasal fractures were the most common injuries sustained by all mechanisms. MVCs were most likely to cause nasal and malar/maxillary fractures (P < 0.01). Falls were the least likely and assaults the most likely to cause mandible fractures (P < 0.001), the most common injury leading to surgical intervention (P < 0.001). Although not statistically significant, fractures sustained in MVCs were the most likely overall to undergo surgical intervention. Age, number of fractures, and alcohol level were statistically significant variables associated with operative management. Age and number of fractures sustained were associated with operative intervention. Although there is a statistically significant correlation between mechanism of injury and type of facial fracture sustained, none of the mechanisms evaluated herein are statistically associated with surgical intervention. Clinical Question/Level of Evidence: Therapeutic, III.

Fracture patterns in the maxillofacial region: a four-year retrospective study

“…This finding is in accordance with other studies on fracture occurrence. Morris et al 8 and Greathouse et al 9 reported a 5:1 and a 2.7:1 ratio in their studies, respectively. In particular, Al Ahmed et al 10 reported a huge bias against men with an 11:1 ratio, which may be due to ethnic characteristics in the UAE where social freedom for women is more restrictive than in other countries.…”

National Analysis of Risk Factors for Nasal Fractures and Associated Injuries in Trauma

“…8 Although previous literature shows that the rate of facial fractures from MVA is decreasing due to new safety methods in cars, such as airbags and seatbelts, the protective effect is far less for nasal fractures. 1,28,31,32 Mouzakes et al suggested that airbags alone may even pose an increased risk of nasal fractures. 33 However, the majority of literature suggests that airbags and seat belts are paramount to injury prevention, especially the reduction of significant morbidity and mortality overall.…”

“…6 Greathouse et al evaluated all operations performed across three Level I trauma centers and one independent surgical center for trauma patients with facial fractures and found that 25.2% of patients with nasal fractures received surgical intervention at a mean of 8.9 days following injury. 1 They also included operations after discharge, while the NTDB only includes operations on the index hospitalization. Since our average hospital LOS was 6.9 days (i.e., longer than would be expected for nasal fracture alone) and due to the lack of follow-up data, our study did not capture all patients who eventually received treatment for their fracture at a later date.…”

“…Blunt trauma was found to be significantly associated with nasal fractures and MVAs were the most common mechanism of injury in the NTDB. The most common cause of nasal fractures reported in previous studies varies depending on the center and study population and includes assaults, MVAs, sports injuries, or falls 127830. One possible reason for the discrepancy between our study and other studies is that the NTDB evaluates subjects categorized as trauma patients, which differs from other studies that may evaluate all patients who present to an institution, including simple falls and sports injuries which commonly are managed by emergency room physicians, or plastic surgeons and otolaryngologists in the ambulatory setting 811.…”

A Cross-sectional Study of the Association between Homelessness and Facial Fractures

“…For the general adult population, the primary mechanisms of facial fractures are motor vehicle accidents, assault, and falls. 7,8 However, assault has increasingly become the primary mechanism of facial fractures in U.S. urban centers such as Detroit, Boston, and Chapel Hill. 9–11 Common types of facial fractures in the general population include nasal bone, mandible, and mala/maxilla fractures.…”