Caracterización y retos en la clasificación de fracturas malares. Serie de casos en un hospital de tercer nivel en la ciudad de Cali, Colombia / Characterization and challenges in the classification of malar fractures. Case series in a third level hospital in the city of Cali, Colombia

Introducción y objetivo: Las fracturas del malar son las fracturas faciales más frecuentes después de las nasales y se asocian preferentemente a accidentes de tránsito. En nuestro medio no disponemos de trabajos que exploren las caracteriticas de esta condicion. Nuestro objetivo es caracterizar las condiciones asociadas a las fracturas malares en la ciudad de Cali, Colombia. Material y método: Estudio observacional descriptivo en pacientes que consultan en el Hospital Universitario del Valle y atendidos por Cirugía Plástica entre agosto de 2019 y marzo de 2020 con diagnóstico de fractura malar por escáner facial. Registramos las variables edad, sexo, origen, procedencia, escolaridad, ocupacion, estado civil, mecanismo de trauma, ciudad del trauma, clasificacion de fracturas del malar, lateralidad, fractura del arco cigomático y fracturas faciales asociadas. No incluimos análisis sobre el manejo de las fracturas. Resultados: Identificamos 25 fracturas malares en 24 pacientes. El 88% en mayores de 18 años; 83.3% varones; el grupo etáreo con más casos fue el de 21-30 años (25%). La causa más común fue el trauma contuso (50%), seguido por las caídas (21%) y accidentes de tránsito (21%). La fractura malar tipo 3 impactada según Knight y North fue la más común (36%). Conclusiones: Encontramos que, en nuestro estudio, el trauma contuso fue la causa más frecuente de fractura malar. Consideramos que la información obtenida puede ser util para que la autoridad local se plantee estrategias para reducir su incidencia. Al clasificar el patron de fractura no se encuentra un tipo único de fractura, sino de combinaciones, lo que nos lleva a pensar que se requiere una nueva clasificación. (AU)

Background and objective: Malar fractures have been described as the most frequent facial fractures after nasal ones. These are frequently associated with traffic accidents. In our environment we do not have studies that explore the characteristics of this condition. Our objective is to characterize the conditions associated with malar fractures in the city of Cali, Colombia. Methods: A descriptive observational study is carried out in patients who consult at the Hospital Universitario del Valle and are cared for by the Plastic Surgery Section between August 2019 and March 2020, with a diagnosis of malar fracture in the facial scan. The variables age, sex, origin, education, occupation, marital status, mechanism of trauma, city of trauma, classification of malar fractures, laterality, fracture of the zygomatic arch and associated facial fractures were recorded. Analysis of the management of fractures is not included. Results: We identified 25 malar fractures in 24 patients; 88% in people over 18 years old; 83.3% were men; the age group with the most cases were 21-30 years old (25%); the most common cause was blunt trauma (50%), followed by falls (21%) and traffic accidents (21%). Type 3 malar fracture impacted according to Knight and North was the most common (36%). Conclusions: Blunt trauma is the most frequent cause of malar fracture in our study. The information obtained can be useful for the local authority to consider strategies to reduce its incidence. When classifying the fracture pattern, a single type of fracture is often not found and, on the contrary, there were combinations which leads us to think that a new classification is required. (AU)

Facial fractures in post-revolution Tunisia as violence indicator: About 476 cases.

INTRODUCTION: On January 2011, Tunisia had known a revolution. To move from dictatorship to democraty project, the country suddenly fell into political instability, which was accompanied by a wave of social violence. Traumatology, and, particularly, maxilla-facial traumatology, is usually a reliable indicator of the degree of violence. AIM: The aim of this study was to establish the epidemiological profile of facial fractures during the various phases of political transition through which Tunisia has passed since revolution (2012-2016). PATIENTS AND METHODS: A retrospective cross-sectional study was conducted among all patients with facial fractures admitted to the department of Oral and Maxillo facial Surgery of University Hospital of Sahloul during five years (2012-2016). Fractures diagnosed late at the sequelae stage were excluded. Data of patients were recorded according to medical files, including cause of injury, age and gender, injury mechanisms and type of facial fracture. RESULTS: During the period of the study, a total of 476 patients were identified, with a sex-ratio of 7.2 to 1, patients ranged in age from 1 year to 76-years-old with a mean age of 27 years. Assaults were the most common cause of injury (39.1%). Mandible was fractured in 257 cases (54.2%) followed by zygoma (116 cases, 24.4%), nasal bone (99 cases, 20.8%) and Orbital walls (98 cases, 20.6%). DISCUSSION: The epidemiological profile of facial fractures in Tunisia has been changed since 2011. Facial fractures occur mainly after assaults, which are an indicator of increased social violence accompanying political instability present in our country.