Facial Fractures: Demographics and Injury Patterns in a Level 1 Trauma Center
Facial Fractures Demographics and Injury Patterns in a Level 1 Trauma Center
Joshua M. Adkinson, MD, Ramon Garza, III, MD, Jarom N. Gilstrap, MD, Nathan F. Miller, BS, Sherrine M. Eid, MPH, Robert X. Murphy, Jr., MD, MS.
PURPOSE
With increasing age, an individual's potential for exposure to various mechanisms of trauma may change. This may impact the types of facial fractures sustained and the likelihood for surgical intervention. The objective of this study is to examine the impact of patient demographics on facial fractures at our Level 1 Trauma Center.
METHOD
An IRB-approved review of the Network Trauma Registry from 2006-2010 was performed: age, sex, mechanism, Injury Severity Score (ISS), Glasgow Coma Score (GCS), blood alcohol level (BAL), length of stay (LOS), type of facial fracture (nasal, maxillary/malar, orbital, mandible), and operative intervention were documented. A logistic regression was performed using SPSS 15.0 (SPSS Inc, Chicago, IL).
RESULT
The database identified 23,318 patients; 1686 patients with facial fractures with 910 patients sustaining 2094 fractures by MVC, fall, or assault. This cohort included 866 nasal, 504 malar/maxillary, 434 orbital, and 290 mandible fractures sustained in 509 MVC, 229 falls, and 172 assaults. Nasal fractures were the most common injuries sustained by all age groups (56.8% of all patients). Mandible fractures were the least frequently sustained facial fracture in patients older than 45yo, and decreased dramatically in the subset older than 80yo (p<0.0001). There was no age-related statistically significant difference in the likelihood of sustaining an orbital fracture (p=0.087) (Table 1). Patients in the 18-44yo age group had a statistically significantly higher ISS, BAL, and LOS (p<0.001). 23.8% of patients underwent surgical intervention and this peaked in the 18-44 yo age group (p<0.001) (Table 2). With increasing age, facial fractures from MVC decreased, while fractures sustained in falls increased. Assaults peaked in the 18-44yo age group (p<0.0001) (Figure 1).
Table 1. Facial Fracture Rate By Age Group
| Fracture Type
| |||
Age Group (years)
| Nasal (n=866)**
| Malar/Maxillary (n=504)*
| Orbital (n=434)***
| Mandible (n=290)*
|
<18
| 82 (48.8%)
| 37 (22.0%)
| 54 (32.1%)
| 47 (28.0%)
|
18-44
| 370 (53.6%)
| 237 (34.4%)
| 190 (27.5%)
| 195 (28.3%)
|
45-64
| 227 (60.9%)
| 159 (42.6%)
| 99 (26.5%)
| 53 (14.2%)
|
65-79
| 132 (61.4%)
| 75 (34.9%)
| 72 (33.5%)
| 21 (9.8%)
|
80-89
| 109 (58.0%)
| 60 (31.9%)
| 66 (35.1%)
| 14 (7.4%)
|
90+
| 37 (71.2%)
| 11 (21.2%)
| 11 (21.2%)
| 4 (7.7%)
|
Total
| 957 (56.8%)
| 579 (34.3%)
| 492 (29.2%)
| 334 (19.8%)
|
*p<0.0001 **p=0.007 ***p=0.087
Table 2. Facial Fracture Surgical Intervention By Age Group (p<0.001)
Age Group (years)
| Surgical Intervention
| No Surgical Intervention
| Total
|
<18
| 45 (26.8%)
| 123 (73.2%)
| 168 (100.0%)
|
18-44
| 223 (32.3%)
| 467 (67.7%)
| 690 (100.0%)
|
45-64
| 88 (23.6%)
| 285 (76.4%)
| 373 (100.0%)
|
65-79
| 33 (15.3%)
| 182 (84.7%)
| 215 (100.0%)
|
80-89
| 12 (6.4%)
| 176 (93.6%)
| 188 (100.0%)
|
90+
| 1 (1.9%)
| 51 (98.1%)
| 52 (100.0%)
|
Total
| 402 (23.8%)
| 1284 (76.2%)
| 1686 (100.0%)
|
Figure 1. Mechanism of Facial Fracture By Age Group (p<0.0001)
CONCLUSION
Age is associated with differences in the type of facial fractures sustained, mechanism of injury, and the likelihood for surgical intervention. These data emphasize the need to customize prevention strategies and appropriately allocate healthcare resources for patients within different age stratifications.