Background:Over half of patients with facial fractures have associated traumatic brain injury. Based on previous force dynamic cadaveric studies, Lefort type 2 and 3 fractures are more associated with severe injury. Whether this correlates to neurosurgical intervention have not been well characterized. The purpose of this retrospective data analysis is to characterize fracture pattern types in patients requiring neurosurgical intervention and to see if this is different from those not requiring intervention.
Methods:Retrospective data was collected from the trauma registry from 2010-2019. Inclusion criteria: adults over 18, con rmed facial fracture with available neuroimaging, reported traumatic brain injury, and admission to ICU or oor bed. Exclusion criteria: patients less than 18 years old, patients with no neuroimaging, and patients that were deceased prior to initiation of neurosurgical intervention. Data included: basic demographic data, presenting Glasgow Coma Scale (GCS) score, mechanism of injury, type of traumatic brain injury, neurosurgical intervention, and facial fracture type. Retrospective Contingency Analysis with Fraction of Total Comparison was used with Chi-Square analysis for demographic and injury characteristic data.
Results:1172 patients met inclusion criteria. 1001 required no neurosurgical intervention and 171 required intervention. No signi cant difference was seen between the non-intervention group and intervention group in terms of demographic data or baseline injury characteristics except for presenting GCS. A signi cant difference was seen between groups for presenting Glasgow Coma Scale (c 2 =67.71, p<0.001). The intervention group had greater number of patients with GCS<8 compared to the non-intervention group. Fracture patterns were overall similar between the non-intervention group compared to intervention group (c 2 =4.518, p=0.92), however subset analysis did reveal a 2 fold increase in Lefort type 2 fractures and notable increase in Lefort type 3 and panfacial fractures in the intervention group. The intervention group was further divided into those requiring external ventricular drain or intracranial pressure monitor only vs. patients requiring craniectomy, craniotomy, or burr holes with or with external ventricular drain or intracranial pressure monitor. A signi cant difference was seen between groups (c 2 =20.02, p=0.03). The craniectomy, craniotomy, or burr hole group was much more likely to have Lefort type 2 or 3 fractures compared to the external ventricular drain or intracranial pressure monitor group only.
Conclusions:Lefort type 2 and type 3 fractures are signi cantly associated with requiring neurosurgical intervention.An improved algorithm for managing these patients has been proposed in the discussion. Ongoing work Page 3/13 will focus on validating and re ning the algorithm in order to improve patient care for trauma patients with facial fracture and traumatic brain injury. This study's retrospective nature serves as a limitation. The study was also limited by th...