Epidemiologic features of facial injuries among motorcyclists

The prevalence of helmet use in motorcyclists around the world: a systematic review and meta-analysis of 5,006,476 participants

Road traffic injuries present a significant public health burden, especially in developing countries. This systematic review and meta-analysis synthesized global evidence on motorcycle helmet use prevalence by including 299 records across 249 articles involving 5,006,476 participants from 1982 to 2022. The findings revealed a declining trend in helmet use prevalence over the past four decades, with an overall prevalence of 48.71%. The meta-regression analysis did not find any statistically significant change in the overall prevalence. Subgroup analysis showed higher helmet use prevalence in observation/survey records (54.29%) compared to crashed patient records (44.84%). Riders/Motorcyclists demonstrated a higher likelihood of wearing helmets than passengers in both observation/survey records (62.61 vs. 28.23%) and crashed patient records (47.76 vs. 26.61%). Countries with mandatory helmet use laws had higher helmet usage prevalence compared to those without (52.26 vs. 37.21%). The African continent had the lowest helmet use rates, while Latin America and the Caribbean regions had higher rates. This study provides a comprehensive overview of global helmet use prevalence, emphasizing disparities between high and low-income countries, variations in law enforcement, and trends over four decades. Targeted interventions are necessary to improve helmet-wearing habits, especially among passengers and regions with low usage rates. Effective legislation and awareness campaigns are crucial for promoting helmet use and reducing road traffic injuries burden.

The immediate impact of mandatory helmet law on maxillo-facial trauma: A comparative study in a major trauma center, Uttar Pradesh

Aim

To analyze the effect of the mandatory helmet rule in helmet usage among motorcycle riders and on facial trauma and to determine the significance of difference in the possibility of facial trauma between the helmeted and non-helmeted motorcycle riders.

Setting and Design

A retrospective comparative study conducted in a major trauma center at Uttar Pradesh.

Material and Method

Data for the present study was obtained from records of the Emergency Department of Trauma Center, for a period of two months before and after the implementation of The Motor Vehicles Act in UP. The study included patients with a history of non-fatal motorcycle accidents who sustained facial injuries regardless of the presence of injuries to other areas of the body during the study period. Information regarding helmet usage during the accident was also recorded. The results were compared between the pre-law period and post-law period.

Statistical Analysis Used

Sample t-test was applied to find the level of significance.

Results

Out of 219 injured patients, 152 (69.40%) subjects were not wearing helmets, whereas only 67 (30.59%) subjects were wearing helmets. It was observed that around 68.18% of people stated wearing helmets after law implementation with a statistical significance (P value < 0.05).

Conclusion

Our study shows that the mandatory helmet rule with elevated penalty rates has significantly increased the usage of helmet among the motorcycle riders, and it also proves that the possibility of facial trauma is significantly higher in non-helmeted riders when compared to helmeted riders.

Changing Trends in the Pattern of Maxillofacial Injuries in Helmeted Motorcycle Accident Patients when Compared to Non-helmeted Motorcycle Accident Patients

Aim

Motorcycle accidents are the most predominant type of road traffic injuries in India. This prospective study aimed to evaluate the patterns of maxillofacial injuries in the three types of helmeted and non-helmeted individuals.

Materials and Methods

All the patients reporting to the maxillofacial trauma unit of Sanjay Gandhi hospital with maxillofacial injuries were considered. The patients were analyzed for helmet wearing status, type of helmet worn-full-face, open-face and half-helmet, strap and visor fixation status, fit of the helmet, ownership of the helmet, helmet standardization, obeying traffic rules, alcohol consumption status, speed of the vehicle, volume of the engine, licensure of the driver, hard- and soft-tissue maxillofacial injuries were recorded.

Results

A total of 741 patients participated in the study for a period of 10 months, majority being males and of a mean age of 31 years. Most common injuries to the face in the open- and half-helmet group were lacerations of the chin and mandibular fractures. Patients who wore ISI standard full-face helmets with strap and visor fixed experienced least injuries to the face.

Conclusion

This study concluded that out of the three commonly used helmets, half-helmets provided the least protection against maxillofacial injuries during a crash, followed by the open-face helmets. The highest protection was provided by the full-face helmets with ISI standardization when secured properly with strap and visor.

Motorcycle-Associated Ocular Injuries: A Narrative Review

Purpose

Motorcycle-related injuries involving the eye and orbit are not well characterized, with a paucity of prospective studies focusing specifically on motorcycle-associated eye injuries nor literature reviews having been conducted on the subject. To better understand the injury types and descriptive characteristics of patients experiencing motorcycle-associated eye injuries, we sought to conduct a narrative review.

Methods

The research team utilized the following databases: PubMed, EMBASE, and Web of Science to query for English articles from peer-reviewed journals that provided some patient data regarding eye injury due to motorcycle or moped accidents or usage.

Results

A total of 65 studies were included in our qualitative synthesis. Of these studies, 40 (61.5%) were case reports, 20 retrospective case series (30.8%), and five (7.69%) were observational prospective studies. Among the 25 retrospective and prospective studies, 12 (48.0%) of these studies primarily focused on motorcycle-associated injuries. These 65 studies described a wide variety of motorcycle-associated eye injuries, including but not limited to orbital fractures and associated sequelae, foreign bodies, vitreoretinal trauma, neuro-ophthalmic trauma, corneal injuries, open globe injuries, lacerations, and globe avulsions.

Conclusion

The current state of the literature indicates that knowledge regarding the ocular manifestations of motorcycle accidents is limited to mostly case reports and few retrospective cohort studies focused specifically on motorcycle-associated eye injuries. However, it is evident that the types of motorcycle-associated eye injuries are legion and predominantly seen in adult males, potentially leading to severe injuries and loss of vision and blindness.

Patterns of maxillofacial trauma in helmet vs. non helmet wearing two wheeler drivers in a tertiary care center

BACKGROUND/AIMS

The frequency and patterns of maxillofacial fractures vary by country, based on demographic, socioeconomic, cultural and environmental factors. Wearing a helmet is an efficient form of head protection for two-wheeler drivers and is now required in the vast majority of countries. The aim of this study was to compare the patterns of maxillofacial trauma in patients who wore helmets and those who did not.

MATERIALS AND METHODS

The data were gathered from clinical records of patients presenting with maxillofacial trauma between January 2019 and February 2022. The inclusion criteria were met by subjects involved in two-wheeler accidents with comprehensive case records and radiological investigations.

RESULTS

A total of 177 people presented following maxillofacial trauma. The mean age was 34.2 ± 12.7 years. There were 151 (85.3%) males and 26 (14.6%) females. One hundred and two patients had not been wearing a helmet, while 75 patients were wearing a helmet at the time of the accident. Mandible fractures were the most common injury in both groups, followed by zygomatic arch fractures (which were more common in non-helmet users) and dentoalveolar fractures in helmet users.

CONCLUSION

There was a significant difference in the pattern and severity of maxillofacial trauma in helmet users and non-helmet users.

The Association of Helmet Use with the Occurrence of Maxillofacial Injuries Following Bicycle or Scooter Accidents: A Retrospective Cohort Study

Study Design

Retrospective Cohort Study.

Objective

Yearly, bicycle and scooter accidents in the Netherlands amount to 90 thousand emergency department visits. Maxillofacial injuries are common after cycling or scooter accidents. To prevent these injuries, helmet use might be beneficial. However, the effect of helmet use on maxillofacial injuries remains unclear. The aim of this retrospective study is to assess the effect of helmet use on maxillofacial injuries in patients who had a bicycle or scooter accident.

Methods

We collected data from the emergency department of the Erasmus Medical Center in the period from October 2017 to October 2019. Patients that were involved in a bicycle or scooter accident and subsequently received a CT scan of the head were included. We compared the incidence of maxillofacial injuries in helmeted cyclists and scooter users to non-helmeted users. Descriptive and analytic statistics were computed. Level of statistical significance was set at p < 0.05.

Results

Helmet use among scooter users was associated with a significant reduction in maxillofacial fractures (p < 0.001) and soft tissue injuries (p < 0.001). Helmet use among cyclists was not associated with a reduction in maxillofacial fractures (p = 0.17) or soft tissue injuries (p = 0.30). Helmet use was not associated with a reduction in soft tissue injuries of the lower face in both cyclists (p = 0.47) and scooter users (p = 0.24).

Conclusions

Helmet use should be considered among cyclists and scooter users to prevent maxillofacial injuries. Especially unhelmeted scooter users might benefit from helmet use as this is associated with a lower incidence of maxillofacial injuries.

Do Helmet Use and Type Influence Facial Trauma Occurrence and Severity in Motorcyclists? A Systematic Review and Meta-analysis

PURPOSE

This article consists of a systematic review of the literature, which verified whether the use and types of helmets reduce the occurrence and severity of facial fractures in hospitalized motorcyclists after traffic accidents.

MATERIALS AND METHODS

Prevalence studies and cohort studies, published in Latin American languages with no restrictions on publication dates, were considered. Two authors independently screened reference lists for eligible articles, assessed them for inclusion criteria, and extracted the data using a specific form. Twenty-six articles were selected, all prevalence studies.

RESULTS

The patients who used a helmet had a lower prevalence and severity of facial fractures, compared to patients who did not wear a helmet. There were no differences in the occurrence of lower third fractures between patients who used or did not wear a helmet at the time of the trauma; as well as in meta-analysis of occurrence and severity of facial trauma between helmet types (open or closed).

CONCLUSIONS

It can be concluded that the use of helmet leads to a lower number of fractures and severity of trauma when compared to nonuse. Regarding the type of helmet, there was no difference in the occurrence and severity of facial fracture in individuals who used closed or opened helmets.

Evaluation of injuries sustained by motorcyclists in approach-turn crashes in Taiwan

OBJECTIVES

In western countries, a typical car-motorcycle crash occurs at an intersection where a car manoeuvres into the path of an oncoming motorcycle, which involves a car driver violates motorcycle's right of way (ROW). In Taiwan, however, a unique type of crash (approach-turn crash) occurs when a turning (including U-turn) motorcycle frequently infringes upon a car's ROW. The primary objective of this study was to examine injuries sustained by motorcyclists in this unique type of crash.

METHOD

Using the linked data from the National Taiwan Crash Database and the National Health Insurance Research Data from 2003 to 2015, this study examined several anatomical injuries (e.g., head and face, neck, chest and abdomen, spine, and lower extremities), as well as the resulting injury severity (e.g., death within 30 days, hospitalisation, and emergency visit only/outpatient, and length of hospital stay). Variables examined include demographic data (sex, age, alcohol use, license status, and helmet use), vehicle attributes (engine size, type of crash partner, and crash type), road and environmental factors (curvature, crash location, day of week and time of crash). Injuries sustained by motorcyclists in an approach-turn motorcycle-turning crash (motorcycle is a ROW violator) were compared with those sustained by motorcyclists in an approach-turn car-turning crash (car is the ROW violator).

RESULTS

A total of 21,919 motorcyclists were enrolled, of whom 18,041 and 3878 were motorcyclists involved in approach-turn car-turning and motorcycle-turning crashes, respectively. The percentage of death within 30 days; hospitalisation; length of hospital stay; and injuries to the head and face, neck, and chest and abdomen were significantly higher for motorcyclists in approach-turn motorcycle-turning crashes. Results of logistic regression models revealed that riding under the influence of alcohol and riding without a licence were associated with death/hospitalisation, and injuries to particular body regions (head and face, neck, and chest and abdomen). Helmet use was associated with a decreased likelihood of head and face and neck injuries.

CONCLUSION

Motorcyclists tended to be more severely or fatally injured and had increased head and face, neck, and chest and abdomen injuries when they were ROW violators than when their ROWs were violated at an intersection. Efforts to curb drunk riding and unlicensed riding may constitute effective intervention points.

Maxillofacial Injuries in Motorcyclists Following the Implementation of Helmet

Background:

It has been reported that 20%–60% of all people injured in road traffic accidents (RTAs) tend to have some form of maxillofacial injury. Mangalore city, Karnataka State, India, traffic police has enforced the law to wear helmets to tackle the problem. The outcome of the initiative till date was not measured. Therefore, the objective of the study was to assess the prevalence of maxillofacial injuries among the victims of motorized two-wheeler RTAs, following the passing of the helmet law.

Materials and Methods:

The study was conducted at the Accident and Emergency Department of K.S. Hegde Medical College and Hospital and at the Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India. The inclusion criteria were the patients who had two-wheeler accidents during the time period of 2016–2017 was collected. The data related to age, gender, helmet wearing, diagnosis, and type of orthopedic injuries was included. A descriptive statistics was calculated along with 95% confidence interval; correlation coefficient and odds ratio using STATA software.

Results:

A total of N = 347 individuals were included in the study. The mean age of the individuals was 33.7 (2–85) years, and the median age was 32 years. 81.55% (N = 283) were male and 18.44% (N = 64) were female. Among the individuals, 51.5% (N = 179) were not wearing helmets and 44.38% (N = 154) of them were males. A total of 25.07 (N = 87) individuals had orthopedic injuries and 16.42% (N = 57) individuals had orthopedic injuries who were not wearing helmets.

Conclusion:

Under the limitations of the study, we conclude that majority of the two-wheelers are not wearing helmets. This study has demonstrated that the impact of wearing helmet on occurrence of craniofacial and orthopedic injuries is less.

Psychological Impact of Facial Trauma

Examination of the mental state of patients suffering from facial trauma is rarely ever recorded, let alone screening them for posttraumatic stress disorders (PTSDs) or generalized anxiety disorder. Providing early support to the patient in light of such psychological conditions can improve the overall quality of life. The aim of this study was to perform a literature review to assess the relation of mental state disorders to facial trauma in terms of their prevalence, assess screening methodology, and also to evaluate the prognosis of individuals subjected to psychological intervention/screening at an early stage of clinical examination. Research databases such as ScienceDirect, Google Scholar, PubMed, and Medline were searched using the keywords "psychological trauma," "facial trauma," and "PTSD." Only meta-analyses, systematic reviews, and original research articles in the English language were included in the study. Correspondence to journal editors and clinician opinions were excluded from the study. Out of a total of 459 results, only 8 articles satisfied the inclusion criteria of the study. The literature review showed that patients suffering from orofacial trauma had significantly increased levels of mental state disorders such as PTSD and generalized anxiety disorder, more so in victims of assault. The results of this literature review clearly point toward an increased prevalence of mental state disorders in patients suffering from facial trauma, which warrants for early intervention in this regard to improve the quality of life of these patients.

Maxillofacial injuries among trauma patients undergoing head computerized tomography; A Ugandan experience

Aim:

The aim of this study was to investigate epidemiological features of maxillofacial fractures within trauma patients who had head and neck computed tomography (CT) scan at the Mulago National referral hospital.

Methods:

CT scan records of trauma patients who had head scans at the Department of Radiology over 1-year period were accessed. Data collected included sociodemographic factors, type and etiology of injury, and concomitant maxillofacial injuries.

Results:

A total of 1330 trauma patients underwent head and neck CT scan in the 1-year study period. Out of these, 130 were excluded due to incomplete or unclear records and no evidence of injury. Of the remaining 1200, 32% (387) had maxillofacial fractures. The median age of the patients with maxillofacial fractures was 28 (range = 18–80) years and 18–27 age group was most common at 47.5%. Road traffic accidents constituted 49.1% of fractures. The single most affected isolated bone was the frontal bone (23%). The number of maxillofacial bones fractured was predicted by age group (df = 3 F = 5.358, P = 0.001), association with other fractures (df = 1 F = 5.317, P = 0.03).

Conclusions:

Good matched case–control prospective studies are needed to enable us tease out the finer difference in the circumstances and pattern of injury if we are to design appropriate preventive measures.

Prevalence, pattern, etiology, and management of maxillofacial trauma in a developing country: a retrospective study

OBJECTIVES

This retrospective study aims to evaluate the prevalence of maxillofacial trauma in a developing country, along with its pattern, etiology and management. Data for the present study were collected from the Department of Dentistry, ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai in India.

MATERIALS AND METHODS

The medical records of patients treated for maxillofacial injuries between May 2014 and November 2015 were retrospectively retrieved and analyzed for prevalence, pattern, etiology, and management of maxillofacial trauma. SPSS software version 16.0 was used for the data analysis.

RESULTS

Maxillofacial fractures accounts for 93.3% of total injuries. The mean and standard deviation for the age of the patients were 35.0±11.8 years and with a minimum age of 5 years and maximum age of 75 years. Adults from 20 to 40 years age groups were more commonly involved, with a male to female ratio of 3:1. There was a statistically significantly higher proportion of males more commonly involved in accident and injuries (P <0.001).

CONCLUSION

The most common etiology of maxillofacial injury was road traffic accidents (RTA) followed by falls and assaults, the sports injuries seem to be very less. In RTA, motorized two-wheelers (MTW) were the most common cause of incidents. The majority of victims of RTA were young adult males between the ages of 20 to 40 years. The malar bone and maxilla were the most common sites of fracture, followed by the mandible. The right side of the zygomatic complex was the predominant side of MTW injury. The majority of the zygomatic complex fractures were treated by conservative management. Open reduction and internal fixation were performed for indicated fracture patients.

Lesões craniofaciais decorrentes de acidentes por motocicleta: uma revisão integrativa

Resumo: Os acidentes de trânsito têm constituído um problema de saúde pública que mais cresce no Brasil e no mundo, com destaque para as motocicletas. Além dos altos índices de mortalidade, destacam-se também as lesões e sequelas causadas aos sobreviventes ao acidente. As lesões de face são comuns neste tipo de acidente, causando deformidades estéticas e funcionais no rosto, necessitando de reabilitação. Foi realizada uma busca na literatura para mapear as lesões na região craniofacial decorrentes de acidentes de trânsito por motocicleta, buscando também suas possíveis implicações para a Comunicação Humana. As bases de dados Pubmed, Lilacs e Scielo foram acessadas, selecionando os artigos pelos títulos, em seguida pelos resumos, para ao final selecionar os artigos para leitura na íntegra. Após este processo, foram selecionados 10 estudos para a revisão. Na região facial, as fraturas mais frequentes foram nos ossos da Mandíbula, Zigomático e Nasal, por serem os mais proeminentes na região. Destacaram-se os Traumas Cranianos como os tipos de lesões com maior gravidade, uma vez que podem levar ao óbito. Apesar do detalhamento das lesões, as sequelas e dados sobre a reabilitação dessas vítimas de acidentes por motocicletas foram raros na literatura.

Analysis of 1,545 Fractures of Facial Region-A Retrospective Study

Incidence and etiology of facial fractures vary from region to region due to various constituents. This study was carried to evaluate the patterns and distribution of fractures in the facial region among different age groups of patients in both males and females caused due to various etiologies. This is a retrospective epidemiological study, which was performed on patients with fractures in the maxillofacial region during a period of 2005 to 2013 at Mamata Dental College and Hospital, Khammam, India. A total of 1,015 patients with 1,545 fractures were referred for treatment to department of oral and maxillofacial injuries surgery, of Mamata Dental College and Hospital, with a mean age of 31.19. The ratio of males (859):females (156) is 5.5:1. Injuries caused by motorbike injuries (34.9%) are highest. The highest frequency of fractures caused by various reasons is seen more in third decade (39%). Mandible (43.81%) is the most common fracture site in the face. Among soft tissue injuries most commonly seen are lacerations (43%). This study differentiates the etiological factors causing facial trauma in several age groups. Results of this study suggest outcomes indicate that more reliance on individual transport on motor vehicles has increased the frequency of facial bone fractures. Regardless of age, motor vehicle accidents were high in all age groups except the first decade of life and above 60 years of age when traffic accidents dominated. Thus effectiveness of current preventive measures is to be assessed, followed by instituting new guidelines for prevention and inflexible traffic rules shall be levied. More epidemiological surveys can, if encouraged to measure the frequency of fractures, better the world.

Study of the pattern of maxillofacial fractures seen at a tertiary care hospital in north India

AIM

The present study was planned to investigate the etiology of maxillofacial injuries and to analyze the pattern of maxillofacial factures as well as the various factors influencing their distribution.

STUDY DESIGN

A one year cross-sectional study was done and 1,108 patients with maxillofacial fractures were analyzed consecutively from April 2010 to March 2011 who reported to the department of Oral and Maxillofacial Surgery in the Centre for Dental Education & Research and Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. A performa was designed to collect the data that included age and sex distribution, etiology, influence of alcohol, type of fractures, use of restraints devices, associated injuries and treatment delivered.

RESULTS

Out of 1,108 patients, 89.62 % were males with a male:female ratio of 8.63:1. The 21-30 year age group was found to be maximum (39.98 %). Road traffic accidents accounted for 49.01 %, followed by assault (22.38 %) and fall from height (21.66 %). Two wheelers were the most commonly involved vehicle. Out of 437 road traffic accident patients (excluding pedestrian, n = 106), only 52.40 % were found to be using restraints devices at the time of accident. Totally 25.45 % patients were under the influence of alcohol at the time of injury. According to anatomical distribution of fractures, mandibular fractures (33.57 %) were most prevalent, followed by maxilla (31.13 %), nasal (28.33 %) and zygoma (24.36 %). Head injuries (18.32 %) were found to be the most common associated injuries followed by lower limb fractures.

CONCLUSION

The motive behind executing this article is to analyze the various trends of facial fractures and all those factors that affect their distribution. A perfect understanding of pattern of maxillofacial fracture will assist the executors of health care in the treatment planning and management of facial injuries. Knowledge gained from the present study would influence in assessing the effectiveness of existing preventive measures and elaboration of future preventive measures and conducting new research.

The impact of mandatory helmet law on the outcome of maxillo facial trauma: a comparative study in kerala

INTRODUCTION

Motorcyclists comprise the majority of road-traffic victims in low and middle income countries,and consequently, the majority of the road-traffic victims globally. Simple measures can be taken to make safer on the roads, which include enforcement of safety measures like seat belt and helmets. The compulsory Helmet law was enforced in Kerala on 18/06/07. Resistance to legislation on motorcycle helmets still coexists world wide with debate on the effectiveness of helmets. In an attempt to analyze the protective effect of helmets on facial injuries a comparative study was conducted in Government Dental College, Calicut, which is a major trauma centre in northern Kerala.

METHODS

Data for the present study was obtained from the patients who have reported to the Emergency Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, for a period of 6 months immediately after the implementation of strict helmet rule in Kerala. For the study all patients with a history of nonfatal motor cycle accident sustaining facial injuries were included. The results were compared with the study conducted in the same institution in the pre law period.

RESULTS

The study demonstrates the protective effect of motorcycle helmets in decreasing the morbidity of maxillofacial trauma.There was a marked decrease in incidence of motorcycle-related injuries, remarkable increase in helmet usage and better outcome in helmeted individuals in the post law period.

CONCLUSION

Road traffic injury control is a public health problem. Health and medical professionals have an ethical responsibility to educate and arrange for the safety of individuals. Helmets are effective in preventing or reducing the severity of motorcycle-related injuries and in a developing country like India, enforced mandatory motor cycle helmet law is potentially one of the most cost effective interventions available.

Characteristics of associated craniofacial trauma in patients with head injuries: An experience with 100 cases

BACKGROUND

Facial fractures and concomitant cranial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults.

AIMS AND OBJECTIVES

To analyze the characteristics of head injuries and associated facial injuries, the management options and outcome following cranio-facial trauma.

METHODS

This retrospective review was performed at Justice K. S. Hegde Charitable Hospital, and associated A. B. Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore. Following Ethical Committee approval, hospital charts and radiographs of 100 consecutive patients of cranio-facial trauma managed at the Department of Oral and Maxillofacial Surgery and Neurosurgery between January 2004 and December 2004 were reviewed.

RESULTS

Majority of the patients were in the 2nd to 4th decade (79%) with a male to female ratio of -8.09:1. Road traffic accidents were the common cause of craniofacial trauma in present study (54%) followed by fall from height (30%). Loss of consciousness was the most common clinical symptom (62%) followed by headache (33%). Zygoma was the most commonly fractured facial bone 48.2% (alone 21.2%, in combination 27.2%). Majority of patients had mild head injury and managed conservatively in present series. Causes of surgical intervention for intracranial lesions were compound depressed fracture, contusion and intracranial hematoma. Operative indications for facial fractures were displaced facial bone fractures. Major causes of mortality were associated systemic injuries.

CONCLUSION

Adult males are the most common victims in craniofacial trauma, and road traffic accidents were responsible for the majority. Most of the patients sustained mild head injuries and were managed conservatively. Open reduction and internal fixation with miniplates was used for displaced facial bone fractures.

Comparison of standard and nonstandard helmets and variants influencing the choice of helmets: A preliminary report of cross-sectional prospective analysis of 100 cases

Background:

The literature does not offer the rate of protection provided by different types of helmets used, especially as it applies to developing countries. We hypothesize that standard versus nonstandard types of helmets might differ in the rate of complications of head and neck trauma occurring in victims of motorcycle accidents. Here we report the rate of occurrence, the type of injuries and differences thereof in standard and nonstandard helmet bearers, and its relevance to protection from serious injury.

Methods:

The data were gathered from a data set of motorcycle accident victims admitted to the emergency department of Sina Hospital (Teheran/Iran). A cross-sectional study was designed for a 6-month period of time, June to December 2007. Variants analyzed included: demographics, types of helmets used, level of education of the victims (as in: being trained for using helmets and status of holding a valid driving license). The latter variants were evaluated for possibly influencing the outcome of the injured motorcyclists using either kind of helmets.

Results:

Among a total of 576 injured motorcyclists who had head, face, or neck injuries, 432 (75%) were using some kind of helmet. A total of 144 (25%) of the injured patients were admitted to the neurosurgical emergency service. There were 100 patients whose data sheets contained all variables which could be included in the pilot analysis of this cohort.

Discussion:

All 100 subjects were male patients with the age range of 32 ± 11 years. Twenty-five percent were using standard helmets at the time of accident, 43% had no cranio-facio-cervical injury except very mild skin abrasions, and 23% had facial injury, including skin lacerations needing sutures, two nasal bone fractures, and no maxillofacial damage. Among the patients using standard helmets, 44% had head injuries which needed to be taken care of (mostly nonoperatively), while 61% using nonstandard helmets had head trauma (P > 0.05). The other variables did not reach a significant value affecting the use of either standard or nonstandard helmets in prevention of craniofacial damages.

Conclusion:

This pilot analysis (comprising the data from 100 cases of motorcycle accidents) could not demonstrate statistically significant differences in injury patterns of different types of helmets and variants influencing their respective use. However, it can lead the way for further analysis of larger and more comprehensive head trauma databases regarding factors contributing to the issue of head injury.

Psychological issues in acquired facial trauma

The face is a vital component of one's personality and body image. There are a vast number of variables that influence recovery and rehabilitation from acquired facial trauma many of which are psychological in nature. The present paper presents the various psychological issues one comes across in facial trauma patients. These may range from body image issues to post-traumatic stress disorder symptoms accompanied by anxiety and depression. Issues related to facial and body image affecting social life and general quality of life are vital and the plastic surgeon should be aware of such issues and competent to deal with them in patients and families.

Prevalence of maxillofacial injuries by motorized two wheeler road traffic accidents in Bangalore city

INTRODUCTION

Two wheeler users in India are the most vulnerable for road fatalities and two wheelers constitute the major portion of vehicular traffic.

OBJECTIVES

To assess the prevalence of maxillofacial injuries among the victims of motorized two wheeler road traffic accidents in Bangalore city.

MATERIALS AND METHODS

Medical records of cases reported during January 2006-June 2007 to hospitals were considered and data regarding age, sex, date of trauma, rider or pillion rider, alcohol consumption, site of injury on the face and associated injuries to other parts of the body were recorded.

RESULTS

The prevalence of injuries among males and females was in the ratio of 3:1. Most of them were in the age group of 21-30 years. Most of the cases were recorded on Saturdays (17.4%) and in the months of August (9%) and September (9.7%) and the least number of cases were reported in January, March and June (2.1%) of 2007. The decrease in number of cases coincides with the implementation of the Helmet Rule in the city.

CONCLUSION

There is a need to stress on the importance of usage of helmets and adherence to traffic rules during the high-risk periods to reduce the incidence of road traffic accidents and accompanying maxillofacial injuries.

Pattern of craniofacial injuries in patients admitted to Tanta University Hospital--Egypt

The goal of this work was to determine the craniofacial injury patterns in hospitalized patients to facilitate the awareness, by identifying, describing and quantifying trauma for use in planning and evaluation of preventive programs. Two-hundred and fifty five patients with craniofacial injuries were registered at the department of neurosurgery in Tanta University Hospital. Data were collected including age, gender, medical history, cause of injury and type of injury, location and frequency of soft tissue injuries, skull fractures, facial bone fractures, brain injuries and concomitant injuries, patient symptoms, clinical signs and the radiological findings. The most common causes of craniofacial injuries were road traffic accidents, followed by activity of daily life and assaults. Gender distribution showed that, males were at higher risk than females with a ratio of 5.5/1. In total of skull fractures, 47.84% were fissure fracture and 24.31% were depressed fractures. In total of brain injuries, 7.06% for concussion, 4.71% for contusion, 10.98% for brain laceration, 14.12% for pneumocephalus and 36.47% for brain edema. Regression analysis revealed increased risk for skull fractures and brain injuries in traffic accidents were 84.78%, 94.20%, respectively, and 59.14%, 50.54% in activity of daily life, but the probability of soft tissue injuries increase in traffic accident and violence.

A review of risk factors and patterns of motorcycle injuries

Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.

Helmets for preventing injury in motorcycle riders

BACKGROUND

Motorcycle crash victims form a high proportion of those killed or injured in road traffic crashes. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.

OBJECTIVES

To assess the effects of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.

SEARCH STRATEGY

We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2007), MEDLINE (up to April 2007), EMBASE (up to April week 16, 2007), CINAHL (January 1982 to February 2003), TRANSPORT (up to issue 12, 2006) (TRANSPORT combines the following databases: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Websites of traffic and road safety research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.

SELECTION CRITERIA

We considered studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. We included any studies that compared an intervention and control group. Therefore the following study designs were included: randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.

DATA COLLECTION AND ANALYSIS

Two authors independently screened reference lists for eligible articles. Two authors independently assessed articles for inclusion criteria. Data were abstracted by two independent authors using a standard abstraction form.

MAIN RESULTS

Sixty-one observational studies were selected of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for death and head injury outcomes. Motorcycle helmets were found to reduce the risk of death and head injury in motorcyclists who crashed. From four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.

AUTHORS' CONCLUSIONS

Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

Development of an engineering autologous palatal mucosa-like tissue for potential clinical applications

The goal of this study was to optimize key processes in recreating functional and viable palatal mucosa-like tissue that would be easy to handle and would promote wound healing. Normal human gingival fibroblasts and epithelial cells and a clinically useful biomaterial, CollaTape, were used. Structural and ultrastructural analyses showed that the gingival fibroblasts and epithelial cells adhered to the biomaterial and proliferated. Following a 6-day culture, using 10(5) fibroblasts and 10(6) epithelial cells, a well-organized palatal mucosa-like tissue was engineered. The engineered epithelium displayed various layers, including a stratum corneum, and contained cytokeratin 16-positive cells located in the supra-basal layer. This palatal mucosa-like engineered tissue was designed to meet a variety of surgical needs. The biodegradable collagen membrane (CollaTape) contributed to the flexibility of the engineered tissue. This engineered innovative tissue may contribute to the reconstruction of oral soft-tissue defects secondary to trauma, congenital defects, and acquired diseases.

Motorcycle helmets and spinal cord injury: helmet usage and type

The objective of this study was to assess the role of helmets and helmet type in relation to injury to the cervical spinal cord. It was based on a consecutive series of 110 motorcyclists with neurological damage to the spinal cord admitted alive (referred to as acute survivors) to a specialist spinal cord injuries unit at an Australian hospital. Cases were those with injury to the cervical spinal cord and controls were those with injury to the cord of other segments of the spine. The study showed that there was no significant difference in the odds of cervical spinal cord injury among unhelmeted and helmeted motorcyclist acute survivors. In addition, it confirmed the findings of a recently published Australian fatality study demonstrating no difference in the odds of cervical spinal cord injury among full-face and open-face helmet wearers. These results contrasted with the findings of earlier studies. In consideration of the limitations of existing research on the role of helmets in spinal cord injury, further study is required based on a larger series or a series having a higher proportion of non-wearers and open-face helmet wearers, including both survivors and those killed, and including assessment of cord and non-cord spinal injuries separately, helmet type, head impact, and helmet retention.

Maxillofacial fractures masking traumatic intracranial hemorrhages

Maxillofacial trauma may mask intracranial injuries prompting intensive care treatment. The purpose of this study was to identify whether craniofacial fracture patterns predispose patients with maxillofacial fractures to different types of intracranial hemorrhages. Within 7 years, 6649 patients with craniomaxillofacial injuries were admitted for treatment. The charts of the patients were analyzed according to age, sex, cause and mechanism of injury, type and location of facial injury, and intracranial trauma; 2195 sustained maxillofacial fractures. Statistical analyses were followed by logistic regression analyses for the four main types of intracranial hemorrhage to determine the impact of the different maxillofacial fractures. Intracranial hemorrhages in 212 patients (9.7%) occurred as epidural (2.5%), subdural (4.3%), subarachnoid (5.3%), and intracerebral hemorrhages (6.3%). Le Fort, orbit, nose, zygoma, and maxillary fractures increased the risk for accompanying intracranial hemorrhage by two- to fourfold (P < 0.05). Basal skull fractures caused a multiplication of the risk up to 17-fold, while fractures of the cranial vault were associated with a risk up to 14-fold. Nearly 10% of patients with craniomaxillofacial fractures sustain intracranial hemorrhages requiring frequently immediate neurosurgical intervention. Those patients, suffering from central midface fractures and skull base fractures, are prone to highly significant elevated risks of intracranial hemorrhage.

Helmets for preventing injury in motorcycle riders

BACKGROUND

Motorcycle crash victims form a high proportion of those killed or injured in road traffic accidents. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.

OBJECTIVES

To quantify the effectiveness of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.

SEARCH STRATEGY

Databases including the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to February 2003), EMBASE (January 1985 to February 2003), CINAHL (January 1982 to February 2003), IRRD (International Road Research Documentation), TRANSDOC, TRIS (Transport Research Information Service), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Web sites of traffic and road accident research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.

SELECTION CRITERIA

We considered for inclusion studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. Studies included any that compared an intervention and control group and, therefore, included any randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently screened reference lists for eligible articles. Two reviewers independently assessed articles for inclusion criteria. Data were abstracted by two independent reviewers using a standard abstraction form.

MAIN RESULTS

Fifty-three observational studies were identified of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for mortality and head injury outcomes. Motorcycle helmets appear to reduce the risk of mortality although, due to heterogeneity in study design, an overall estimate of effect was not calculated. There was some evidence that the effect of helmets on mortality is modified by speed. Motorcycle helmets were found to reduce the risk of head injury and from five well-conducted studies the risk reduction is estimated to be 72% (OR 0.28, 95%CI 0.23, 0.35). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.

REVIEWERS' CONCLUSIONS

Motorcycle helmets reduce the risk of mortality and head injury in motorcycle riders who crash, although the former effect may be modified by other crash factors such as speed. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries

INTRODUCTION

Cranio-maxillofacial trauma management requires pertinent documentation. Using a large computerized database, injury surveillance and research data describe the whole spectrum of injuries. The goal of this study was to assess the effect of the five main causes of accidents resulting in facial injury on the severity of cranio-maxillofacial trauma.

PATIENTS AND METHODS

During a period of 10 years (1991-2000) 9,543 patients were admitted to the Department of Oral and Maxillofacial Surgery, University Hospital of Innsbruck with cranio-maxillofacial trauma. Data of patients were prospectively recorded including cause of injury, age and gender, type of injury, injury mechanisms, location and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures and concomitant injuries. Statistical analyses performed included descriptive analysis, chi square test, Fisher's exact test, and Mann-Whitney's U test. This was followed by logistic regression analyses for the three injury types to determine the impact of the five main causes on the type of injury at different ages in facial trauma patients.

RESULTS

Five major categories/mechanisms of injury existed: in 3,613 (38%) cases it was activity of daily life, in 2991 (31%) sports, 1170 (12%) violence, in 1,116 (12%) traffic accidents, in 504 (5%) work accidents and in 149 (2%) other causes. A total of 3,578 patients (37.5%) had 7,061 facial bone fractures, 4,763 patients (49.9%) suffered from 6,237 dentoalveolar, and 5,968 patients (62.5%) from 7,769 soft tissue injuries. Gender distribution showed an overall male-to-female ratio of 2.1 to 1 and the mean age was 25.8+/-19.9 years; but both varied greatly depending on the injury mechanism (facial bone fractures: 35.4+/-19.5 years, higher risk for males; soft tissue injuries: 28.7+/-20.5, no gender preference; dentoalveolar trauma: 18+/-15.6, elevated risk for females). For patients sustaining facial trauma, logistic regression analyses revealed increased risks for facial bone fractures (225%), soft tissue lesions (58%) in patients involved in traffic accidents, and dental trauma (49%) during activities of daily life and play accidents. When compared with other causes, the probability of suffering soft tissue injuries and dental trauma, but not facial bone fractures, is higher in sports-related accidents, 12 and 16%, respectively.

CONCLUSION

This study differentiated between injury mechanisms in cranio-maxillofacial trauma. The specially trained surgeons treating cranio-maxillofacial trauma are the primary source of information for the public and legislators on implementing preventive measures for high-risk activities. In facial trauma, older persons are prone to bone fractures (increase of 4.4%/year of age) and soft tissue injuries (increase of 2%/year of age) while younger persons are more susceptible to dentoalveolar trauma (decrease of 4.5%/year of age).

Facial trauma and the risk of intracranial injury in motorcycle riders

STUDY OBJECTIVE

We describe the associations among facial fracture, helmet use, skull fracture, and traumatic brain injury in injured motorcycle riders.

METHODS

The study population consisted of 5,790 motorcycle riders who sustained an injury from a crash in 1991, 1992, or 1993 and were identified from emergency department or hospital records in 28 hospitals in 11 California counties. Diagnostic information was abstracted from ED or hospital records and coded to the 1990 Abbreviated Injury Scale. The risk of traumatic brain injury was examined by using odds ratios and 95% confidence intervals. Logistic regression analysis was used to examine the associations among helmet use, skull fracture, facial fracture, and traumatic brain injury.

RESULTS

Facial injury was diagnosed in 24.4% of all injured riders, including 411 with one or more facial fractures. The odds of traumatic brain injury were 3.5 times greater with than without a facial injury and 6.5 times greater with a facial fracture than with no facial injury. Significantly increased odds of traumatic brain injury were observed for fracture of all bones of the face, but the highest odds of traumatic brain injury were found in riders with fractures to bones of the upper face. Helmet use status and the presence of skull fracture were found to be significant effect modifiers. Facial fracture with concurrent skull fracture increased the risk of traumatic brain injury dramatically. Facial fractures are more strongly associated with traumatic brain injury in helmeted riders.

CONCLUSION

The presence of facial fractures increases the risk of traumatic brain injury. Riders with facial fractures should be screened for brain injury, regardless of helmet use status.

Spinal injury patterns resulting from car and motorcycle accidents

STUDY DESIGN

Retrospective data analysis.

OBJECTIVES

To determine spinal injury patterns and clinical outcomes in patients involved in automotive accidents.

SUMMARY OF BACKGROUND DATA

The records of 22,858 patients collected prospectively as part of the Trauma Audit Research Network (UK) Database (1993-2000).

METHODS

Analysis of the records of 1121 motorcyclists and 2718 car occupants involved in automotive trauma.

RESULTS

Spinal injury occurred in 126 (11.2%) motorcyclists and 383 (14.1%) car occupants. Victims were predominantly young (mean ages: motorcycle 30.2 years, car 37.8 years) and male (motorcycle 88.9%, car 60.6%). The mean Injury Severity Scores were 18.8 and 15.1, respectively. Isolated spinal injuries occurred in 30 (23.8%) motorcyclists and 130 (33.9%) car occupants. The thoracic spine was most commonly injured in motorcyclists (54.8%), and the cervical spine was most commonly injured in car occupants (50.7%). Multiple regions were injured in 14 (10.3%) motorcyclists and 33 (8.5%) car occupants. Nine motorcyclists and 43 car occupants required spinal surgery. Median hospital stays were 11.5 days (range 0-235 days) and 10 days (range 0-252 days) in the motorcyclists and car occupants, respectively. There were 13 (10.3%) motorcycle- and 26 (6.8%) car-related deaths.

CONCLUSION

Spinal injury patterns may reflect differing mechanisms of injury between the restrained car occupant and unrestrained motorcyclist. The motorcyclists were more severely injured, had more extremity trauma, a higher mortality rate, and a spinal injury pattern consistent with forced hyperflexion of the thoracic spine. The predominance of cervical injuries and higher incidence of neck and facial injuries in car occupants may reflect abdominothoracic seat belt restraint. The high frequency of multilevel injuries reaffirms the need for vigilance in patient assessment.

Autopsy study of motorcyclist fatalities: the effect of the 1992 Maryland motorcycle helmet use law

OBJECTIVES

This study sought to determine the impact of Maryland's all-rider motorcycle helmet law (enacted on October 1, 1992) on preventing deaths and traumatic brain injuries among motorcyclists.

METHODS

Statewide motorcyclist fatalities occurring during seasonally comparable 33-month periods immediately preceding and following enactment of the law were compared.

RESULTS

The motorcyclist fatality rate dropped from 10.3 per 10 000 registered motorcycles prelaw to 4.5 postlaw despite almost identical numbers of registered motorcycles. Motorcyclists wearing helmets had a lower risk of traumatic brain injury than those not wearing helmets (odds ratio = 0.31, 95% confidence interval = 0.14, 0.68).

CONCLUSIONS

Maryland's controversial motorcycle helmet law appears to be an effective public health policy and may be responsible for saving many lives.

Head injury mechanisms in helmet-protected motorcyclists: prospective multicenter study

BACKGROUND

In a prospective study, three research groups at Hannover (H) and Munich (M) in Germany and Glasgow (G) in the United Kingdom collected data from motorcycle crashes between July 1996 and July 1998 to investigate head injury mechanisms in helmet-protected motorcyclists.

METHODS

The head lesions of motorcyclists with Abbreviated Injury Score-Head (AISHead) 2+ injuries and/or helmet impact were classified into direct force effect (DFE) and indirect force effect (IFE) lesions. The effecting forces and the force consequences were analyzed in detail.

RESULTS

Two-hundred twenty-six motorcyclists (H, n = 115; M, n = 56; and G, n = 55) were included. Collision opponents were cars (57.8%), trucks (8.0%), pedestrians (2.3%), bicycles (1.4%), two-wheel motor vehicles (0.8%), and others (4.2%). In 25.4% no other moving object was involved. The mean impact speed was 55 km/h (range, 0-120 km/h) and correlated with AISHead. Seventy-six (33%) motorcyclists had no head injury, 21% (n = 48) AISHead 1, and 46% (n = 103) AISHead 2+. Four hundred nine head lesions were further classified: 36.9% DFE and 63.1% IFE. Lesions included 20.5% bone, 51.3% brain, and 28.1% skin. The most frequent brain lesions were subdural hematomas (22.4%, n = 47) and subarachnoid hematomas (25.2%, n = 53). Lesions of skin or bone were mainly DFE lesions, whereas brain lesions were mostly IFE lesions.

CONCLUSION

A modification of the design of the helmet shell may have a preventative effect on DFE lesions, which are caused by a high amount of direct force transfer. Acceleration or deceleration forces induce IFE lesions, particularly rotation, which is an important and underestimated factor. The reduction of the effecting forces and the kinetic consequences should be a goal for future motorcycle helmet generations.

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.

Head injury in facial impact--a finite element analysis of helmet chin bar performance

The chin bar of a motorcycle helmet protects the rider from facial and head injuries. To evaluate the protective performance of chin bars against head injuries from facial impacts, an explicit finite element method was used to simulate the Snell Memorial Foundation test and a proposed drop test. The maximum acceleration and Head Injury Criterion (HIC) were employed to assess the impact-absorbing capability of the chin bar. The results showed that the proposed approach should be more practical than the Snell test, and provided more information for improving the chin bar design to protect against head injuries. The shell stiffness was important in determining the protective ability of the chin bar, but a chin bar with only an outer shell and comfort foam offered inadequate protection. An energy-absorbing liner was essential to increase the protective performance of the chin bar and the liner density should be denser than that used in the cranial portion of the helmet. For the chin bar with energy-absorbing liner, a shell design that is less stiff would provide better protection.

Maxillofacial injuries caused by all-terrain vehicle accidents

With the rise in popularity of all-terrain vehicles (ATVs), especially in rural America, injuries associated with their use are becoming more commonplace. A retrospective review was conducted of 153 patients with ATV-related injuries seen at West Virginia University Hospitals between January 1990 and June 1996. Of these patients, 33 had maxillofacial injuries. Only 2 of 21 (9.5%) patients noted to be wearing helmets had facial injuries, whereas 17 of 19 (89.5%) patients who had facial injuries were not wearing helmets. Most patients with maxillofacial injuries occurring at night had been drinking alcohol. Injury Severity Scores were worse for those patients with maxillofacial injuries, as well as for those patients who had been drinking alcohol. Patients with maxillofacial injuries were more likely to require a stay in the intensive care unit. Furthermore, children with facial injuries had higher Injury Severity Scores and longer hospital stays than the adults. To reduce these accidents and related injuries, the industry, local and federal governments, and ultimately individuals must change their attitudes regarding these potentially dangerous vehicles.