Facial Fractures as a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies

Single institutional experience of geriatric maxillofacial trauma patients: a retrospective study

Objectives

: Geriatric maxillofacial trauma (GMT) is not an uncommon entity in maxillofacial surgery practice. The aim of the study was to document the experience with GMT cases in a single private dental college and hospital in an effort to uncover the etiology, prevalence, fracture sites, and various types of treatment in GMT.

Materials and Methods

: This was a retrospective study conducted at Saveetha Dental College and Hospital in Chennai. Data from patients diagnosed with maxillofacial trauma between January 2019 and December 2023 were retrieved from hospital records, and those aged ≥60 years were included in the study. Patients' basic demographic details and the prevalence, etiology, fracture sites, and various treatments of GMT were recorded and analyzed. The collected data were entered into a structured database and analyzed using IBM SPSS Statistics ver. 23.0 (IBM).

Results

: A total of 867 cases were screened, and 37 (4.04%) GMT patients were finally included in the study. The mean age of the study population was 65±5 years, and there were six females and 31 males. A ground-level fall was the common etiology (n=17), and the most common site of fracture was the mandible (n=15). Open reduction and internal fixation (ORIF) was the most common treatment modality (n=24) among included cases.

Conclusion

: Although the prevalence of GMT was low, ground-level falls were a common reason for trauma; hence, geriatric patients require comprehensive care in home and outdoor settings. Enhanced anesthetic and surgical techniques have made ORIF a suitable treatment approach in the present era.

The epidemiology of alcohol involved facial injuries

PURPOSE

Alcohol use has been shown to affect injury patterns and risk of trauma. This study aims to characterize the epidemiologic characteristics of alcohol involved facial injuries presenting to US emergency departments.

METHODS

This study reports a cross-sectional analysis of patients with facial injuries within the National Electronic Injury Surveillance System (NEISS). Demographics, disposition, and mechanism of injury were compared between facial injury patients with reported/suspected alcohol consumption prior to or during the time of injury (AIFI+) and facial injury patients with no alcohol consumption (AIFI-).

RESULTS

A total of 37,777 facial injuries were reported within the NEISS. Out if these, 3,336 patients experienced an alcohol involved facial injury (AIFI+). AIFI + patients were younger than AIFI- patients (47 vs. 57, p < 0.001), more likely to be male (68.5% vs. 31.5%, p < 0.001), and more likely to be White (51.6% vs. 53.6%, p = 0.03). Patients with AIFI were less likely to be injured at home (41.5% vs. 45.5%, p < 0.001) and more likely to be injured in the street (8.5% vs. 4.5%, p < 0.001). Disposition differed with AIFI + patients less likely to be treated and released (78.8% vs. 83.3%, p < 0.001) and more likely to leave without being seen (3.8% vs. 1.8%, p < 0.001).

CONCLUSIONS

Our study reports that AIFI + patients are younger, more likely to be injured on the street, and more likely to be injured by stairs than AIFI- patients. Additionally, patients with an AIFI + are more likely to leave the hospital without being seen.

Patterns of Midface and Mandible Fractures in a Government Hospital

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (P = .06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (P = .019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (P = .028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence.

What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries?

BACKGROUND

Patients sustaining maxillofacial fractures are at risk for associated injuries (AIs) to other body regions. The incidence of AIs is reported to be from 20 to 35%. AIs may be life-threatening and play a key role in considering first-line management at the emergency department, as well as planning the definitive treatment of maxillofacial fractures.

PURPOSE

The study aimed to determine the frequency and risk factors for AIs in patients with maxillofacial fractures.

STUDY DESIGN, SETTING, SAMPLE

The investigators designed and implemented a retrospective cohort study of patients with facial fractures treated at Central Hospital (Lahti, Finland) from January 1, 2009 through December 31, 2019. All adult patients with verified maxillofacial fractures were included. Patients under 18 years of age were excluded from the study.

PREDICTOR VARIABLE

The predictor variable was the location of the maxillofacial fractures grouped into three categories: mandible alone, midface alone, and both midface and mandible.

MAIN OUTCOME VARIABLE(S)

The primary outcome variable was associated body region injuries coded as present or absent. The secondary outcome variable was the location of the AI categorized as skull, neck, thorax, pelvis, or extremity injuries.

COVARIATES

Other study variables included demographic data (age, sex, alcohol use), Glasgow Coma Scale, and etiology (fall, traffic- and bicycle accident, assault, pedestrian hit by motor vehicle, work-related, or sports/free-time injuries).

ANALYSES

Continuous variables were analyzed for normal distribution using the Shapiro-Wilks test and compared with categorical variables using the Mann-Whitney test. The univariate analyses of categorical variables were analyzed by the χ2 test (P ≤ .05 was considered statistically significant).

RESULTS

During the study period, 443 adult (≥18) patients had maxillofacial fractures. AIs were present in 88 subjects (20%). The mean age was 47.6 years (range 18-91); 52 years with AIs (range 19-91), and 47 years (range 18-92) without AIs (P = .03). Subjects with midface and mandible + midface fractures had greater risk to AIs compared to mandibular fractures (relative risk 2.0, P = .002, relative risk 2.8, P = .009).

CONCLUSION AND RELEVANCE

Every fifth maxillofacial trauma patient had an associated injury. Trauma patients should be evaluated in institutions with trauma protocols and imaging modalities before determining and executing the treatment plan for maxillofacial fractures.

Head & Neck Trauma in the Geriatric Population

Craniofacial trauma in the geriatric population is increasing as our population ages. Due to loss of bone quality and medical comorbidities, injuries for minor trauma can be severe. A more extensive medical evaluation is usually warranted in this population before proceeding with surgery. In addition, unique surgical considerations exist in the repair of atrophic and edentulous bony fractures. Some quality improvement measures have already been undertaken but more is needed to help standardize care in this vulnerable population.

Age Effects in Facial Fracture Trauma: Disparities in Multisystem Injuries in Non-Fall-Related Trauma

Background and objective Facial fractures represent a growing concern among an aging population prone to falls. In light of this, this study aimed to investigate differential facial fracture patterns and outcomes based on age effects. Determining the differences between the severity and type of facial fractures in populations of different ages will help guide clinical decision-making when managing patients with facial fractures. Methods This was a single-center study involving trauma registry data, from July 1, 2016, to January 31, 2022. The inclusion criteria were based on the International Classification of Diseases (ICD-10) diagnosis of facial fracture. A linear regression was performed to ascertain the effects of predictor variables on the likelihood that a facial fracture trauma patient would experience various age effects on injury location, mortality, and morbidity. Results A total of 1575 patients were included in the analysis. A significant regression equation was found (F(47,1476)=42.46, p<0.01), with an R2 of 0.57. Older facial fracture trauma patients were more likely to be female (β=3.13, p<0.01) with fractures to their zygoma (β=2.57, p=0.02). Higher Abbreviated Injury Scale (AIS) facial region scores (β=2.21, p=0.03), longer hospital length of stay (β=0.07, p=0.02), and in-hospital mortality (β=10.47, p<0.01) were also associated with older age. Older age was additionally associated with a higher level of several morbidity markers. Younger facial fracture trauma patients were more likely to be African American (β=-5.46, p<0.01) or other, non-Caucasian race (β=-8.66, p<0.01) and to have mandible fracture patterns (β=-3.63, p<0.01). The younger patients were more likely to be fully activated (β=-3.10, p<0.01) with a higher shock index ratio (SIR) (β=-7.36, p<0.01). Injury mechanisms in younger facial fracture patients were more likely to be assault (β=-12.43, p<0.01), four-wheeler/ATV accident (β=-24.80, p<0.01), gunshot (β=-15.18, p<0.01), moped accident (β=-13.50, p<0.01), motorcycle accident (β=-12.31, p<0.01), motor vehicle accident (β=-16.52, p<.01), or pedestrian being struck by a motor vehicle (β=-10.69, p=0.02). Conclusions Based on our findings, age effects impact facial fracture patterns and outcomes. Younger patients are more likely to experience multisystem injuries via non-fall trauma. On the other hand, older patients are more likely to experience more severe primary facial injuries. Older patients are also at a higher risk of fall-related trauma. Disparities also exist between genders and races, with male and non-Caucasian patients being at a higher risk of injury from facial fractures at a younger age. With an aging population, the prevalence of falls is likely to increase. Thus, facial fractures represent a growing healthcare burden and warrant future investments related to care and treatment.

Architectural accessibility and perception of falls of elderly people in the peridomicile: mixed method

OBJECTIVE

To describe contents, structure and origin of social representations about falls by elderly people, the peridomiciliary structural conditions that predispose to falls, and to relate the implications of these empirical evidence on the routine of the elderly in the architectural context.

METHOD

Convergent mixed method by triangulation. Qualitative approaches(structural, n=195 and procedural, n=40of the Theory of Social Representations) and quantitative (descriptive sectional, n=183) were used. Elderly people enrolled in primary care were interviewed at home in 2018. Analysis techniques: categorical-thematic, prototypical, statistical, and deductive according to Leininger.

RESULTS

Categories of analysis: 1) Peridomicile: fall scenario and 2) Aging and vulnerability: risk of falls in peridomicile. The following environmental characteristics were precursors to falls: uneven floors, holes, unevenness and objects in the pathway. Feelings and behaviors allocated in the possible central core are associated, justifying falls, and determining their causes.

CONCLUSION

There was an association between the peridomiciliary architectural environment and the predictive characteristics of the risk of falls.

Emergency versus semi-elective management of mandible fractures: a Maxillofacial Trainee Research Collaborative (MTReC) study

INTRODUCTION

Recent evidence suggests that acute emergency management of mandible fractures does not improve surgical outcomes yet is associated with increased financial burden. Current NHS policy advocating for increased adoption of day-case and semi-elective surgical procedures to reduce bed strain must be balanced with providing timely, effective treatment. Our research aims to determine patient groups currently managed via semi-elective admission and whether this can be extended to other groups to provide safe and effective management of mandible fractures.

METHODS

A multi-national trainee-led audit of mandibular fractures across 49 units was completed by the Maxillofacial Trainee Research Collaborative (MTReC). Each unit prospectively collected data on fractures on admission and at follow-up. Data collected included patient demographics, behaviour, health, injury, timing to intervention and surgical complications.

RESULTS

Data were collected on 947 mandibular fractures. Of the surgically managed patients, 649 (90%) were managed via acute emergency admission at the time of presentation, while 68 (10%) were managed semi-electively. Patient demographics, injury pattern and mechanism appeared to significantly affect timing of management, whereas patient behaviour, health status, timing of injury and presentation did not. Semi-elective management was associated with a significantly shorter inpatient duration (0.9 versus 1.9 days, p=0.000) with no differences in readmission, antibiotic usage or surgical complications (p=1.000, RR 1.030).

CONCLUSION

Our study demonstrates the efficacy of planned admissions and semi-elective management of mandibular fractures. Simple mandibular fractures in compliant patients are suitable for semi-elective treatment. Holistic patient assessment and tailored surgical planning is crucial in determining admission modality to effectively manage mandibular trauma.

Assessing the Need for Transfer to a Trauma Center for Isolated Craniofacial Injury in a Rural State

Management of craniofacial injuries typically defaults to plastic, ophthalmology, and oral maxillofacial surgeons which can challenge these surgical subspecialists' capacity to care for both trauma victims and non-trauma patients. Evaluating the need to transfer patients to a higher level of trauma care for isolated craniofacial injuries warrants investigation. Our 5-year retrospective study measured the frequency of craniofacial injuries and subsequent surgical interventions in elderly trauma patients' ≥65 years old. Eighty-one percent of patients consulted with plastic surgeons and 28% with ophthalmology. Twenty percent had craniofacial surgery with the majority of surgical interventions were in soft tissue (97%), mandible (48%), and Le Fort III (29%) injuries. A patient's ISS, GCS, head and face AIS, and presents of spinal or brain injury had no statistically significant impact on injury repair. Elderly patients with isolated craniofacial trauma may be better served by pretransfer consultation with a surgical subspecialist to determine the necessity.

Surgical Management of Facial Fractures in Geriatric Patients

ABSTRACT

Facial fractures comprise a substantial part of traumatology. Due to aging of the population, over the last 20 years, there has been a pattern of redistribution of these fractures with a higher incidence at an older age. The aim of this study was to retrospectively analyze the epidemiology, pattern, and surgical management of facial fractures in geriatric patients presenting at a single tertiary trauma center.This study included patients aged ≥70 years who presented with facial bone fractures between 2008 and 2017 and were treated with surgical interventions. Parameters such as age, sex, American Society of Anesthesiologists classification, Glasgow Coma Scale score, fracture type, fracture mechanism, concomitant injuries, duration of hospitalization, and postoperative complications were evaluated.A total of 300 patients were included: 118 men (39.3%) and 182 women (60.7%). The mean age was 78.8 years. An orbital floor fracture was the most common injury (35.1%). The most common cause of fracture was a fall at home (67%). A total of 113 patients (37.7%) had 162 concomitant injuries, 35 patients (11.7%) suffered from polytrauma, and 7 patients developed postoperative complications. The average length of stay was 1.67 days in the intensive care unit and 5.50 days in the standard ward. Polytrauma, pre-existing medical conditions, and oral anticoagulation had a significant impact on the duration of hospitalization.Facial fractures are common in combination with other injuries. Women are more often affected than men, and falling at home is the most common cause of facial injuries. Postoperative complications are rare.

Stepping into Trouble: Craniomaxillofacial Trauma in the Geriatric Population From Stairway Falls

PURPOSE

The purpose of this study is to determine what potential factors are associated with increased risk of hospital admission among the geriatric population who suffer stairway falls.

MATERIALS AND METHODS

This is a 10-year cross-sectional study that was conducted using the National Electronic Injury Surveillance System (NEISS). Entries whose primary product was categorized under the code 1239 (stairs or steps) were included in this study. Reports were excluded if the injury did not occur within the craniomaxillofacial region. The principal outcome variable was admission rate. Patient and injury characteristics were compared using χ2 and independent sample t tests.

RESULTS

Admission rates were significantly associated with sex (P < .01), age group (P < .01), race (P < .05), craniomaxillofacial region (P < .01), and primary diagnosis (P < .01). Relative to the females, males (OR, 1.458; P < .01) were independently associated with an increased odds of admission. Relative to patients aged 65 to 69 years old, patients aged 70 to 79 (OR, 1.247; P < .01), 80 to 89 (OR, 1.438; P < .01), and 90 & over (OR, 1.569; P < .01) were each independently associated with an increased odds of admission. Relative to white patients, black patients (OR, 1.238; P < .01) were each independently associated with an increased odds of admission. Relative to mouth injuries, eyeball injuries (OR, 4.574; P < .01) and head injuries (OR, 4.105; P < .01) were independent risk factors for admission. Relative to abrasions, fractures (OR, 6.013; P < .01) and internal organ injuries (OR, 4.814; P < .01) were each independently associated with an increased odds of admission.

CONCLUSIONS

Age, gender, craniomaxillofacial region, type of injury, and primary diagnosis are all independent risk factors for hospital admissions. Preventative measures need to be taken to safeguard the older geriatric population from craniomaxillofacial trauma associated with stairway falls.

Trends in the incidence, prevalence and years lived with disability of facial fracture at global, regional and national levels from 1990 to 2017

Background

Facial fracture is one of the most common injuries globally. Some types of facial fractures may cause irreversible damage and can be life-threatening. This study aimed to investigate the health burden of facial fractures at the global, regional, and national levels from 1990 to 2017.

Methods

Facial fracture data, including the incidence, prevalence, and years lived with disability (YLDs) from 1990 to 2017, were obtained from the Global Burden of Disease study. We calculated the estimated annual percentage changes (EAPCs) to assess the changes of facial fractures in 195 countries or territories and 21 regions.

Results

From 1990 to 2017, the change in cases of facial fracture incidence was 39% globally, while the age-standardized incidence rate showed a downtrend with an EAPC of 0.00. Syria experienced a ten-fold increase in incidence cases with an EAPC of 9.2, and this condition is largely responsible for the global health burden of facial fractures. The prevalence and YLDs showed a similar trend worldwide as the incidence. Additionally, we found that the incidence, prevalence, and YLDs showed a discrepancy among various age groups with a gradual change of proportion over the past 28 years. The age-standardized rates (ASRs) of facial fractures were nearly twice for male than those for female from 1990 to 2017.

Conclusions

EAPC showed a correlation with the ASRs of facial fractures and had no relationship with socio-demographic index. The proportion of children and elderly suffering from facial fractures slightly changed with time. The ratio of facial fractures between males and females was 2:1. These findings suggest that more targeted and specific strategies based on age and gender should be established in various countries and regions.

Is Decreased Local Bone Quality an Independent Risk Factor for Complications Following Fracture Fixation of Facial Bones

PURPOSE

Although osteoporosis is associated with increased risks of complications of fracture fixation in the orthopedic literature, the association between local bone quality (LBQ) and complications of facial fracture fixation is unknown. The authors aim to identify that if decreased LBQ is an independent risk factor for complications following facial fracture fixation?

METHODS

The authors conducted a prospective cohort study on patients over age of 50 years who underwent open reduction and rigid internal fixation for facial fractures. The primary predictor was LBQ (low or normal), decided by a combination of 3 panoramic indices. Other predictors included age, gender, body mass index (BMI), comorbidities, trauma-related characteristics, etc. The outcome variable was the presence of hardware-related, fracture-healing, wound, or neurosensory complications during 2-year follow-up. Univariate and multivariate regressions were performed to identify any significant association between predictor and outcome variables.

RESULTS

The sample was composed of 69 patients (27 females) with an average age of 58.6 ± 8.6 years and BMI of 25 ± 3.8. Low-LBQ patients were significantly older, more females, had lower BMI, mainly injured from falls, had more complications compared to their normal-LBQ counterparts. However, multivariable logistic regressions demonstrated that only age (adjusted OR: 1.12, P = 0.031, 95% CI: 1.01, 1.23) and diabetes (adjusted OR: 12.63, P = 0.029, 95% CI: 1.3, 122.53) were significantly associated with overall complications after confounding adjustment.

CONCLUSIONS

The results of the present study indicate that reduced LBQ is not an independent risk factor for complications following facial fracture fixation. The increased risk of complications in low-LBQ patients is more likely to be attributed to other age-related comorbidities such as diabetes. Therefore, the authors recommend detailed workup and good control of comorbidities in elderly trauma patient.