Demographic features of patients with concomitant facial fractures and closed head injuries in Maricopa, Arizona.

OBJECTIVE: The aim of this study was to investigate the demographic profile of Native American patients with concomitant facial fractures and closed head injuries (CHIs) and to explore the validation of the craniofacial crumple zone. STUDY DESIGN: This was a retrospective, observational, case-control study of 2131 maxillofacial fractures from 2010 to 2014, of which 173 (8%) had concomitant CHIs. RESULTS: Of the study patients, 133 (77%) were males (mean age 40.6 years). Only 2.1% of the local population was Native American, but this group represented 24% of the patients with CHIs and sustained 4.6 times more (P value < .001) assault injuries and 2.6 times more concussion (P value < .001) compared with other groups. Other trauma comparisons were not significant. Of the 173 study patients, 86 (50%), had blood alcohol levels which exceeded 80 mg/100 mL compared with 93% of the Native Americans. CONCLUSIONS: Native American patients had a highly significant predisposition to violence and road traffic accidents resulting in maxillofacial fractures and CHIs. The high blood alcohol levels found in this group also reflected longstanding serious sociologic problems. This study provides a useful model to investigate the relative ethnic/racial role of comminuted paranasal structures for the protection of the brain (i.e., the crumple zone).

An Asian perspective on improving outcomes for nasal bone fractures by establishing specific treatment options.

OBJECTIVE: To report treatment outcomes of patients with different types of nasal bone fracture, following a tailored treatment protocol. DESIGN: The patterns and the severity of the fractures were determined by a preoperative facial photo and nasal bone computed tomography (CT) retrospectively. SETTING: A tertiary referral centre. PARTICIPANTS: We evaluated 129 patients who underwent surgery between March 2002 and January 2014. Patients were subjected to five different treatment methods depending on the severity of injury. MAIN OUTCOME MEASURES: Medical records were reviewed to assess rates of complications and revision surgery. Cosmetic and functional (the degree of nasal obstruction) outcomes were measured using the Likert scale from 1 (very dissatisfied, severe obstruction) to 5 (very satisfied, no obstruction). RESULTS: The mean elapsed time from injury to surgery was 14.9 days. The overall treatment failure rate, defined as a deformity that required revision, was 6.2%. The patient satisfaction scores for aesthetic and functional outcomes were 3.9 and 4.6 respectively. CONCLUSION: The prudent selection of patients with indication for closed reduction, and further specification of variable treatment options for the various degrees of nasal bone fracture, may be helpful in achieving an improved treatment outcome. LEVEL OF EVIDENCE: level IV.

Race and Sex Differences in Adult Facial Fracture Risk.

IMPORTANCE: There are well-described racial, sex, and age differences related to osteoporosis and hip and/or extremity fractures. Nonetheless, there has been virtually no inquiry evaluating whether these findings carry over to facial fracture. OBJECTIVE: To characterize the incidence of facial fractures by patient demographics and injury mechanism, focusing on whether differences are noted with race, sex, and advancing age. MAIN OUTCOMES AND MEASURES: Retrospective analysis of the National Electronic Injury Surveillance System (NEISS) was performed in October and November 2015, specifically evaluating adult emergency department (ED) visits from 2012 to 2014 related to facial trauma. Entries were organized by age groups (both individual decades as well as younger adults [18-59 years] vs older adults [60-89 years]), sex, and race (white, black, Asian, other/unspecified). Incidence of facial fractures and mechanism of injury were also evaluated. RESULTS: There were 33 825 NEISS entries correlating to 1 401 196 ED (range, 1 136 048-1 666 344) visits for adult facial injury, with 14.4% involving fracture. A greater proportion of facial injuries among younger men (<60 years) were fractures relative to younger women (15.5% vs 12.5%; difference of the mean [DOM], 3.0%; 95% CI, 2.8%-3.1%; P < .001); however, on comparison by sex in elderly populations (≥ 60 years), women had an increased fracture predilection (15.0% vs 14.0%; DOM, 1.0%; 95% CI, 0.8%-1.2%; P < .001). Also, older women had a significantly greater risk of fracture relative to those younger than 60 years (15.0% vs 12.5%; DOM, 2.5%; 95% CI, 2.4%-2.7%; P < .001), a comparison that was significant among whites and Asians. Black women had a significantly decreased risk of fracture in the older aged population. (8.4% vs 9.1%; DOM, 0.7%; 95% CI, 0.2%- 1.3%; P = .001). Both on individual comparisons of younger and older cohorts, white and Asian individuals of either sex had significantly greater rates of facial fracture injury than blacks. Among younger cohorts in either sex, injuries sustained during participation in recreational activities were a significant factor, replaced largely by injuries due to housing structural elements and falls among older cohorts. CONCLUSIONS AND RELEVANCE: There is an increase in the risk of facial fracture among postmenopausal women sustaining facial injuries, with these results significant among whites and Asians. In contrast, a decreased risk was noted on comparison of younger and older black women. Mechanism of injuries also varied significantly by age, race, and sex. LEVEL OF EVIDENCE: 4.

Predictors of mortality, hospital utilization, and the role of race in outcomes in head and neck trauma.

OBJECTIVE: A retrospective cross-sectional analysis was undertaken to determine the impact of race and insurance status on trauma outcomes in patients admitted to a Level I trauma center following head and neck fractures. STUDY DESIGN: Putative predictive factors, including injury mechanism, hemorrhagic shock, injury severity score (ISS), race, gender, and insurance status, were used in a multivariate outcome analysis to determine their influence on length of hospital stay, number of procedures performed, discharge status, and mortality; P < .05 was significant. RESULTS: Proportionately more male patients (76.5%) sustained head and neck fractures compared with females (23.5%). Blacks and Hispanics sustained proportionately more gunshot wounds (GSWs) compared with Whites, 16:1 and 7:1, respectively. There were no significant differences in length of hospital stay and mortality based on race or insurance status. Mortality was related to age, GSW as a mechanism of injury, increasing ISS, and shock on admission. CONCLUSIONS: Minority race and insurance status did not correlate with worse outcomes. Treatment biases in the acutely injured patient with head and neck injuries may be less prevalent than thought, if we consider mortality and utilization of care as primary outcome measures.

Craniomaxillofacial injuries in the United Arab Emirates: a retrospective study.

PURPOSE: To analyze craniomaxillofacial injuries in selected hospitals in the United Arab Emirates (UAE). PATIENTS AND METHODS: This is a retrospective study of craniomaxillofacial injuries treated in 3 major hospitals in the UAE. Patient files were retrieved, reviewed, and analyzed. The main analysis outcome measures were the patients' name, age, and gender and the injuries' time, site, type, treatment and outcome. RESULTS: A total of 288 patients sustained 475 craniomaxillofacial injuries; road traffic accidents caused the majority of injuries. The patients ranged in age from 2 to 82 years (mean, 27.3 years), and the male-to-female ratio was 7:1. The yearly distribution of fractures peaked during 2001, and the monthly distribution peaked in January. The greatest number (41%) of patients were UAE nationals. Most patients (70.5%) had mandibular fractures, and the most common site was the body. There were 139 patients (48.3%) with a total of 171 midface fractures (36%); the most common fracture site was the zygomatic complex (29.8%). The most common treatment for jaw fractures was plating plus intermaxillary fixation. Stable zygomatic complex fractures were closely reduced (elevated), and unstable ones were treated by internal fixation. About 25% of the cases had 1 or more postoperative complication. CONCLUSIONS: Craniomaxillofacial injuries in the UAE included in this study are somewhat similar to those reported in other countries. Differences from other countries are probably related to factors peculiar to the UAE, such as climate, social trends, and the cosmopolitan population.

Incidence of facial fractures resulting in hospitalisation in New Zealand from 1979 to 1988.

The incidence and aetiology of facial fractures resulting in admission to public hospitals in New Zealand in 1987 were investigated retrospectively from data collected by the Health Statistical Services. Data were analysed by the age group, ethnic origin and gender of those affected. During 1987 the overall incidence of facial fractures was 47.9/100,000 of the population. The highest incidence was for Maori males at 152/100,000. A comparison with data for the period 1979 to 1988 showed a decrease for the population as a whole but an increase for those who declared themselves to be Maori. Assault was the most common cause of facial fractures resulting in hospitalisation for both males and females. Sport was the second most common cause of facial fractures with rugby football contributing two-thirds of these. These results indicate where future preventive measures should be targeted.

Fracturas de craneo deprimidas y expuestas: reconstrucción osea en fase aguda

Se estudia la historia clínica de seis pacientes en quienes se practicó la reconstrucción primaria del defecto óseo producido por una fractura deprimida y expuesta del cráneo, en lugar de efectuar la craniectomía y craneoplastía en un segundo tiempo quirúrgico