Prevalence of cervical spine injuries in patients with facial trauma.

OBJECTIVE: Injuries to the spine may accompany facial trauma. By using a large computerized database the goal of this case control study was to assess the association between facial and cervical spine injuries among patients sustaining facial trauma. STUDY DESIGN: During a period of 4 years (1995 to 1998) 3083 patients, 10 years or older, with facial injuries were admitted to the University Hospital of Innsbruck's Department of Oral and Maxillofacial Surgery for facial trauma. Records were analyzed for cause of injury, age and gender distribution, frequency and type of injury, and frequency of cervical spine injuries in relation to facial trauma and concomitant injuries. Two hundred six (6.7%) of these patients had experienced a concomitant cervical spine injury (case group). All other patients (2877) were assigned to the control group of facial trauma only. RESULTS: Facial trauma patients with concomitant cervical spine injuries were significantly older (mean age, 42 vs 34 years); no difference existed for the female/male ratio of 30:70. Sports trauma was the main cause of facial trauma in the control group (37.4%), yet traffic accidents accounted for 43.7% of combined facial and cervical spine injuries in the case group. Central mid face fractures dominated in the case group and lateral mid face fractures in the control group. In the case group cervical spine fractures and dislocations occurred in 19.2%. None of them showed evidence of paralysis. Concomitant brain injuries occurred in 21.6% of the case group and 8.8% of the control group. For patients sustaining facial trauma, logistic regression analysis revealed reduced risks for additional cervical spine injuries in younger patients, female patients, absence of brain injury, and in patients with facial soft tissue lesions alone (58.2%) or dental trauma alone (77.5%). CONCLUSION: The results of this study underline the importance of proper clinical and computed tomographic evaluation in cases of facial fractures for recognition of additional cervical spine trauma. Detection of cervical spine trauma can be missed, especially when pain or symptoms from other parts of the body dominate. The typical patient with concomitant neck and facial trauma is male, 40 years old, and usually involved in a traffic accident.

The incidence of combined facial and cervical spine injuries.

BACKGROUND: The association between facial and cervical spine injuries has been documented. However, only severe spinal injuries were included in previous analyses. It was the purpose of this study to evaluate the incidence of and risk factors for these injury combinations including the complete injury spectrum. METHODS: Between 1995 and 1997, 4,907 patients with cervical spine injuries were treated at our hospital. One hundred five (2.14%) of these patients had suffered a concomitant facial injury. This group was compared with the group of patients with cervical spine injury but without facial trauma. RESULTS: The majority of cases (98%) consisted of minor lesions to both regions. With increasing severity of cervical spine trauma, the risk for facial injury increased. Age and male gender represent significant (p < 0.05) risk factors for combined injuries. CONCLUSION: Patients sustaining cervical spine trauma have a small but real chance of injuring their face as well. The cervical spine must be examined carefully, whenever facial injuries are present.

[Arthroscopic extra-articular Bankart procedure]. / Die arthroskopische extraartikuläre Bankart-Operation.

The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69.7% were classified as excellent, 10.9% as good, 9.7% fair and 9.7% poor. Postoperative complications: the recurrence rate was 9.7%, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3%) and a frozen shoulder in 6 cases 3.6%). 61% of the patients involved in overhead or contact sports returned to their preoperative sport activities.

The arthroscopic extraarticular Bankart repair.

The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69,7 % were classified as excellent, 10,9 % as good, 9,7 % fair and 9,7 % poor. Postoperative complications: the recurrence rate was 9,7 %, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3 %) and a frozen shoulder in 6 cases 3,6 %). 61 % of the patients involved in overhead or contact sports returned to their preoperative sport activities.