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reason for this is likely related to the high-energy mechanism often
associated with fracture of the facial skeleton.
The objective of this study is to examine associations between
modes of presentation, fracture patterns, and concomitant life-threatening
injuries in all facial fractures diagnosed via a radiographic study at
a level 1 trauma center during a predetermined period.
METHODS
After institutional review board approval, all facial fractures
occurring at a level 1 trauma center (University Hospital, Newark,
NJ) between January 2000 and December 2012 were collected
based on International Classification of Disease, Revision 9, codes.
These results were further refined to include only those patients in
the pediatric population (age of 18 years or younger). Patient demo-
graphics were collected as well as mechanism of injury, Glasgow
Coma Scale (GCS) on presentation, fracture locations, concomitant
injuries, and fracture management strategies. Comparisons were made
between type of fracture, mechanism of injury, GCS on presentation,
length of hospital stay, and life-threatening injuries such as cervi-
cal spine injury and intracranial hemorrhage. A significance value
of 5% was used.
RESULTS
During this period, there were 3147 patients with facial fractures
treated at our institution, 353 of which were pediatric patients. Upon
further review, 68 patients were excluded because of insufficient
data for analysis, leaving 285 patients for review, with a total of
431 fractures. The mean age of patients was 14.2 years with a strong
male predominance (78%). The mandible was the most common
bone fractured followed by fractures of the orbit (Table 1). Figure 1
FIGURE 1.
Concomitant injuries.
TABLE 1.
Distribution of Fractures Observed
Male
Female
Total
Number of patients
222
63
285
Mean age, y
14.7
12.7
14.2
Number of fractures
328
103
431
Mandible fractures
118
21
139
Orbital fractures
92
33
125
Zygoma fractures
26
9
35
Nasal fractures
48
21
69
Frontal bone/sinus fractures
21
15
36
Palate fractures
5
2
7
Le Fort variant fractures
18
2
20
TABLE 2.
Fracture Types and Concomitant Injuries
Cervical Spine
Fracture
No Cervical
Spine Fracture
Odds Ratio
(95% CI)
Lumbar/
Thoracic
Spine Fracture
No Lumbar/Thoracic
Spine Fracture Odds Ratio
ICH
No ICH Odds Ratio
Mandible fracture
3
136
NS
3
136
NS
16
123
0.22 (0.12
–
0.41)*
Palatal fracture
1
6
NS
2
5
11.9 (2.0
–
70.1)
†
3
4
NS
Zygoma fracture
4
33
4.9 (1.3
–
18.2)
†
2
35
NS
16
21
2.7 (1.3
–
5.6)
Orbital fracture
8
119 5.2 (1.1
–
25.1)
†
8
119
NS
48
79
3.8 (2.1
–
6.7)*
Nasal fracture
5
64
NS
6
63
4.0 (1.2
–
13.6)
†
30
39
3.4 (1.9
–
6.1)*
Frontal bone/sinus
fracture
3
33
NS
3
33
NS
25
11
10.3 (4.7
–
22.5)*
Le Fort fracture
2
18
NS
1
19
NS
8
12
NS
Skull Fracture No Skull
Fracture
Odds Ratio Long Bone
Fracture
No Long Bone
Fracture
Odds Ratio Abdominal/Pelvic/
Thoracic Injury
No Abdominal/Pelvic/
Thoracic Injury
Odds Ratio
Mandible fracture
14
125 0.33 (0.17
–
0.64)* 14
125
NS
12
126
NS
Palatal fracture
4
3
6.6 (1.4
–
30.2)*
4
3
10.3 (2.2
–
47.9)*
2
5
NS
Zygoma fracture
10
27
NS
5
32
NS
6
31
NS
Orbital fracture
38
89
4.8 (2.4
–
9.4)*
19
108
NS
16
111
NS
Nasal fracture
16
53
NS
10
59
NS
12
57
2.3 (1.0
–
5.1)
†
Frontal bone/sinus
fracture
26
10 23.3 (10.1
–
53.9)* 5
31
NS
7
29
NS
Le Fort fracture
8
12
3.4 (1.3
–
8.9)*
4
16
NS
6
14
4.3 (1.5
–
12.2)*
*
P
<
0.01;
†
P
<
0.05.
CI, confidence interval; ICH, intracranial hemorrhage; NS, not significant.
The Journal of Craniofacial Surgery
•
Volume 25, Number 5, September 2014
© 2014 Mutaz B. Habal, MD
38