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Facial fractures and associated injuries in high- versus low-energy trauma: all are not created equal
Introduction Facial fractures (FFs) occur after high- and low-energy trauma; differences in associated injuries and outcomes have not been well articulated. Objective To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms. Methods W...
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| Published in: | Maxillofacial plastic and reconstructive surgery 2020, 42(6), , pp.1-6 |
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| container_title | Maxillofacial plastic and reconstructive surgery |
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| creator | Hilaire, Cameron St Johnson, Arianne Loseth, Caitlin Alipour, Hamid Faunce, Nick Kaminski, Stephen Sharma, Rohit |
| description | Introduction
Facial fractures (FFs) occur after high- and low-energy trauma; differences in associated injuries and outcomes have not been well articulated.
Objective
To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms.
Methods
We conducted a 6-year retrospective local trauma registry analysis of adults aged 18–55 years old that suffered a FF treated at the Santa Barbara Cottage Hospital. Fracture patterns, concomitant injuries, procedures, and outcomes were compared between patients that suffered a high-energy mechanism (HEM: motor vehicle crash, bicycle crash, auto versus pedestrian, falls from height > 20 feet) and those that suffered a low-energy mechanism (LEM: assault, ground-level falls) of injury.
Results
FFs occurred in 123 patients, 25 from an HEM and 98 from an LEM. Rates of Le Fort (HEM 12% vs. LEM 3%,
P
= 0.10), mandible (HEM 20% vs. LEM 38%,
P
= 0.11), midface (HEM 84% vs. LEM 67%,
P
= 0.14), and upper face (HEM 24% vs. LEM 13%,
P
= 0.217) fractures did not significantly differ between the HEM and LEM groups, nor did facial operative rates (HEM 28% vs. LEM 40%,
P
= 0.36). FFs after an HEM event were associated with increased Injury Severity Scores (HEM 16.8 vs. LEM 7.5,
P |
| doi_str_mv | 10.1186/s40902-020-00264-5 |
| format | article |
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Facial fractures (FFs) occur after high- and low-energy trauma; differences in associated injuries and outcomes have not been well articulated.
Objective
To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms.
Methods
We conducted a 6-year retrospective local trauma registry analysis of adults aged 18–55 years old that suffered a FF treated at the Santa Barbara Cottage Hospital. Fracture patterns, concomitant injuries, procedures, and outcomes were compared between patients that suffered a high-energy mechanism (HEM: motor vehicle crash, bicycle crash, auto versus pedestrian, falls from height > 20 feet) and those that suffered a low-energy mechanism (LEM: assault, ground-level falls) of injury.
Results
FFs occurred in 123 patients, 25 from an HEM and 98 from an LEM. Rates of Le Fort (HEM 12% vs. LEM 3%,
P
= 0.10), mandible (HEM 20% vs. LEM 38%,
P
= 0.11), midface (HEM 84% vs. LEM 67%,
P
= 0.14), and upper face (HEM 24% vs. LEM 13%,
P
= 0.217) fractures did not significantly differ between the HEM and LEM groups, nor did facial operative rates (HEM 28% vs. LEM 40%,
P
= 0.36). FFs after an HEM event were associated with increased Injury Severity Scores (HEM 16.8 vs. LEM 7.5,
P
<0.001), ICU admittance (HEM 60% vs. LEM 13.3%,
P
<0.001), intracranial hemorrhage (ICH) (HEM 52% vs. LEM 15%,
P
<0.001), cervical spine fractures (HEM 12% vs. LEM 0%,
P
= 0.008), truncal/lower extremity injuries (HEM 60% vs. LEM 6%,
P
<0.001), neurosurgical procedures for the management of ICH (HEM 54% vs. LEM 36%,
P
= 0.003), and decreased Glasgow Coma Score on arrival (HEM 11.7 vs. LEM 14.2,
P
<0.001).
Conclusion
FFs after HEM events were associated with severe and multifocal injuries. FFs after LEM events were associated with ICH, concussions, and cervical spine fractures. Mechanism-based screening strategies will allow for the appropriate detection and management of injuries that occur concomitant to FFs.
Type of study
Retrospective cohort study.
Level of evidence
Level III.</description><identifier>ISSN: 2288-8101</identifier><identifier>ISSN: 2288-8586</identifier><identifier>EISSN: 2288-8586</identifier><identifier>DOI: 10.1186/s40902-020-00264-5</identifier><identifier>PMID: 32601595</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Anticoagulants ; Assaults ; Dentistry ; Face ; Facial fractures ; Fractures ; High-energy mechanisms ; Injuries ; Low-energy mechanisms ; Medicine ; Mortality ; Oral and Maxillofacial Surgery ; Outcomes ; Patients ; Plastic Surgery ; Trauma ; Ventilators ; 치의학</subject><ispartof>Maxillofacial Plastic Reconstructive Surgery, 2020, 42(6), , pp.1-6</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020.</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c641t-186076da3d19988519e1fdc549bf4a390a3a56c95446bd886858d50a338fb4d3</citedby><cites>FETCH-LOGICAL-c641t-186076da3d19988519e1fdc549bf4a390a3a56c95446bd886858d50a338fb4d3</cites><orcidid>0000-0002-5902-458X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312115/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2416304254?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25731,27901,27902,36989,36990,44566,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32601595$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002599429$$DAccess content in National Research Foundation of Korea (NRF)$$Hfree_for_read</backlink></links><search><creatorcontrib>Hilaire, Cameron St</creatorcontrib><creatorcontrib>Johnson, Arianne</creatorcontrib><creatorcontrib>Loseth, Caitlin</creatorcontrib><creatorcontrib>Alipour, Hamid</creatorcontrib><creatorcontrib>Faunce, Nick</creatorcontrib><creatorcontrib>Kaminski, Stephen</creatorcontrib><creatorcontrib>Sharma, Rohit</creatorcontrib><title>Facial fractures and associated injuries in high- versus low-energy trauma: all are not created equal</title><title>Maxillofacial plastic and reconstructive surgery</title><addtitle>Maxillofac Plast Reconstr Surg</addtitle><addtitle>Maxillofac Plast Reconstr Surg</addtitle><description>Introduction
Facial fractures (FFs) occur after high- and low-energy trauma; differences in associated injuries and outcomes have not been well articulated.
Objective
To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms.
Methods
We conducted a 6-year retrospective local trauma registry analysis of adults aged 18–55 years old that suffered a FF treated at the Santa Barbara Cottage Hospital. Fracture patterns, concomitant injuries, procedures, and outcomes were compared between patients that suffered a high-energy mechanism (HEM: motor vehicle crash, bicycle crash, auto versus pedestrian, falls from height > 20 feet) and those that suffered a low-energy mechanism (LEM: assault, ground-level falls) of injury.
Results
FFs occurred in 123 patients, 25 from an HEM and 98 from an LEM. Rates of Le Fort (HEM 12% vs. LEM 3%,
P
= 0.10), mandible (HEM 20% vs. LEM 38%,
P
= 0.11), midface (HEM 84% vs. LEM 67%,
P
= 0.14), and upper face (HEM 24% vs. LEM 13%,
P
= 0.217) fractures did not significantly differ between the HEM and LEM groups, nor did facial operative rates (HEM 28% vs. LEM 40%,
P
= 0.36). FFs after an HEM event were associated with increased Injury Severity Scores (HEM 16.8 vs. LEM 7.5,
P
<0.001), ICU admittance (HEM 60% vs. LEM 13.3%,
P
<0.001), intracranial hemorrhage (ICH) (HEM 52% vs. LEM 15%,
P
<0.001), cervical spine fractures (HEM 12% vs. LEM 0%,
P
= 0.008), truncal/lower extremity injuries (HEM 60% vs. LEM 6%,
P
<0.001), neurosurgical procedures for the management of ICH (HEM 54% vs. LEM 36%,
P
= 0.003), and decreased Glasgow Coma Score on arrival (HEM 11.7 vs. LEM 14.2,
P
<0.001).
Conclusion
FFs after HEM events were associated with severe and multifocal injuries. FFs after LEM events were associated with ICH, concussions, and cervical spine fractures. Mechanism-based screening strategies will allow for the appropriate detection and management of injuries that occur concomitant to FFs.
Type of study
Retrospective cohort study.
Level of evidence
Level III.</description><subject>Anticoagulants</subject><subject>Assaults</subject><subject>Dentistry</subject><subject>Face</subject><subject>Facial fractures</subject><subject>Fractures</subject><subject>High-energy mechanisms</subject><subject>Injuries</subject><subject>Low-energy mechanisms</subject><subject>Medicine</subject><subject>Mortality</subject><subject>Oral and Maxillofacial Surgery</subject><subject>Outcomes</subject><subject>Patients</subject><subject>Plastic Surgery</subject><subject>Trauma</subject><subject>Ventilators</subject><subject>치의학</subject><issn>2288-8101</issn><issn>2288-8586</issn><issn>2288-8586</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9kk1v1DAQhiMEolXpH-CALHGBQ8DfsTkgVRWFlSohob1bju3seuu1Wztp1X-PN2kL5cBprJlnXs-M3qZ5i-AnhAT_XCiUELcQwxZCzGnLXjTHGAvRCib4y8c3guioOS1lByFEmHUdIa-bI4I5REyy48ZdaON1AEPWZpyyK0BHC3QpqaZHZ4GPuyn7mvcRbP1m24Jbl8tUQEh3rYsub-7BmPW011-ADgHo7EBMIzDZzf3uZtLhTfNq0KG404d40qwvvq3Pf7SXP7-vzs8uW8MpGtu6F-y41cQiKYVgSDo0WMOo7AeqiYSaaMaNZJTy3grB66qW1SwRQ08tOWk-LrIxD-rKeJW0n-Mmqauszn6tV0pSKTHElV0trE16p66z3-t8PzfMiZQ3SufRm-BUxzjCtkOU0IFax3rYQagdQXzgA8Nd1fq6aF1P_d5Z42K9SHgm-rwS_bbOdKs6gjBCrAp8eBDI6WZyZVR7X4wLQUeXpqIwRRIKQmb0_T_oLk051qseKE4gxYxWCi-UyamU7IanYRBUB_-oxT-q-kfN_lEH6Xd_r_HU8uiWCpAFKLUUNy7_-fs_sr8BGbzOlg</recordid><startdate>20200624</startdate><enddate>20200624</enddate><creator>Hilaire, Cameron St</creator><creator>Johnson, Arianne</creator><creator>Loseth, Caitlin</creator><creator>Alipour, Hamid</creator><creator>Faunce, Nick</creator><creator>Kaminski, Stephen</creator><creator>Sharma, Rohit</creator><general>Springer Singapore</general><general>Springer Nature B.V</general><general>SpringerOpen</general><general>대한악안면성형재건외과학회</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>ACYCR</scope><orcidid>https://orcid.org/0000-0002-5902-458X</orcidid></search><sort><creationdate>20200624</creationdate><title>Facial fractures and associated injuries in high- versus low-energy trauma: all are not created equal</title><author>Hilaire, Cameron St ; Johnson, Arianne ; Loseth, Caitlin ; Alipour, Hamid ; Faunce, Nick ; Kaminski, Stephen ; Sharma, Rohit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c641t-186076da3d19988519e1fdc549bf4a390a3a56c95446bd886858d50a338fb4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anticoagulants</topic><topic>Assaults</topic><topic>Dentistry</topic><topic>Face</topic><topic>Facial fractures</topic><topic>Fractures</topic><topic>High-energy mechanisms</topic><topic>Injuries</topic><topic>Low-energy mechanisms</topic><topic>Medicine</topic><topic>Mortality</topic><topic>Oral and Maxillofacial Surgery</topic><topic>Outcomes</topic><topic>Patients</topic><topic>Plastic Surgery</topic><topic>Trauma</topic><topic>Ventilators</topic><topic>치의학</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hilaire, Cameron St</creatorcontrib><creatorcontrib>Johnson, Arianne</creatorcontrib><creatorcontrib>Loseth, Caitlin</creatorcontrib><creatorcontrib>Alipour, Hamid</creatorcontrib><creatorcontrib>Faunce, Nick</creatorcontrib><creatorcontrib>Kaminski, Stephen</creatorcontrib><creatorcontrib>Sharma, Rohit</creatorcontrib><collection>Springer Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>Korean Citation Index</collection><jtitle>Maxillofacial plastic and reconstructive surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hilaire, Cameron St</au><au>Johnson, Arianne</au><au>Loseth, Caitlin</au><au>Alipour, Hamid</au><au>Faunce, Nick</au><au>Kaminski, Stephen</au><au>Sharma, Rohit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Facial fractures and associated injuries in high- versus low-energy trauma: all are not created equal</atitle><jtitle>Maxillofacial plastic and reconstructive surgery</jtitle><stitle>Maxillofac Plast Reconstr Surg</stitle><addtitle>Maxillofac Plast Reconstr Surg</addtitle><date>2020-06-24</date><risdate>2020</risdate><volume>42</volume><issue>1</issue><spage>22</spage><epage>22</epage><pages>22-22</pages><artnum>22</artnum><issn>2288-8101</issn><issn>2288-8586</issn><eissn>2288-8586</eissn><abstract>Introduction
Facial fractures (FFs) occur after high- and low-energy trauma; differences in associated injuries and outcomes have not been well articulated.
Objective
To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms.
Methods
We conducted a 6-year retrospective local trauma registry analysis of adults aged 18–55 years old that suffered a FF treated at the Santa Barbara Cottage Hospital. Fracture patterns, concomitant injuries, procedures, and outcomes were compared between patients that suffered a high-energy mechanism (HEM: motor vehicle crash, bicycle crash, auto versus pedestrian, falls from height > 20 feet) and those that suffered a low-energy mechanism (LEM: assault, ground-level falls) of injury.
Results
FFs occurred in 123 patients, 25 from an HEM and 98 from an LEM. Rates of Le Fort (HEM 12% vs. LEM 3%,
P
= 0.10), mandible (HEM 20% vs. LEM 38%,
P
= 0.11), midface (HEM 84% vs. LEM 67%,
P
= 0.14), and upper face (HEM 24% vs. LEM 13%,
P
= 0.217) fractures did not significantly differ between the HEM and LEM groups, nor did facial operative rates (HEM 28% vs. LEM 40%,
P
= 0.36). FFs after an HEM event were associated with increased Injury Severity Scores (HEM 16.8 vs. LEM 7.5,
P
<0.001), ICU admittance (HEM 60% vs. LEM 13.3%,
P
<0.001), intracranial hemorrhage (ICH) (HEM 52% vs. LEM 15%,
P
<0.001), cervical spine fractures (HEM 12% vs. LEM 0%,
P
= 0.008), truncal/lower extremity injuries (HEM 60% vs. LEM 6%,
P
<0.001), neurosurgical procedures for the management of ICH (HEM 54% vs. LEM 36%,
P
= 0.003), and decreased Glasgow Coma Score on arrival (HEM 11.7 vs. LEM 14.2,
P
<0.001).
Conclusion
FFs after HEM events were associated with severe and multifocal injuries. FFs after LEM events were associated with ICH, concussions, and cervical spine fractures. Mechanism-based screening strategies will allow for the appropriate detection and management of injuries that occur concomitant to FFs.
Type of study
Retrospective cohort study.
Level of evidence
Level III.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>32601595</pmid><doi>10.1186/s40902-020-00264-5</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-5902-458X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2288-8101 |
| ispartof | Maxillofacial Plastic Reconstructive Surgery, 2020, 42(6), , pp.1-6 |
| issn | 2288-8101 2288-8586 2288-8586 |
| language | eng |
| recordid | cdi_nrf_kci_oai_kci_go_kr_ARTI_9499202 |
| source | Open Access: PubMed Central; Publicly Available Content Database; Springer Nature - SpringerLink Journals - Fully Open Access |
| subjects | Anticoagulants Assaults Dentistry Face Facial fractures Fractures High-energy mechanisms Injuries Low-energy mechanisms Medicine Mortality Oral and Maxillofacial Surgery Outcomes Patients Plastic Surgery Trauma Ventilators 치의학 |
| title | Facial fractures and associated injuries in high- versus low-energy trauma: all are not created equal |
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