Facial Fractures as a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies
Abstract
:Methods
Results
Discussion
Conclusion
Conflicts of Interest
References
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Mandible | 7 |
Palate | 0 |
Zygoma | 11 |
ZMC | 6 |
Orbit | 27 |
NOE | 1 |
Nasal | 10 |
Frontal sinus | 2 |
Le Fort | 3 |
Long bone fracture | No long bone fracture | Odds ratio (95% CI) | Cervical spine fracture | No cervical spine fracture | Odds ratio (95% CI) | |
---|---|---|---|---|---|---|
Orbit fracture | 11 | 76 | NS | 11 | 76 | 3.7 (1.1–12.2)∗∗ |
Nasal fracture | 8 | 40 | NS | 5 | 43 | NS |
Zygoma fracture | 8 | 19 | 6.1 (2.2–17.0)∗ | 4 | 23 | NS |
ZMC fracture | 4 | 11 | 4.1 (1.2 -14.6)∗∗ | 2 | 13 | NS |
Mandible fracture | 2 | 8 | NS | – | – | – |
Frontal fracture | – | – | – | 1 | 11 | NS |
Le Fort fracture | 2 | 2 | 10.7 (1.4–80.9)∗∗ | – | – | – |
Skull fracture | No skull fracture | Odds ratio (95% CI) | ICH | No ICH | Odds ratio (95% CI) | |
Orbit fracture | 4 | 83 | NS | 5 | 82 | NS |
Nasal fracture | 5 | 43 | NS | 4 | 44 | NS |
Zygoma fracture | 2 | 25 | NS | 2 | 25 | NS |
ZMC fracture | 2 | 13 | NS | 2 | 13 | NS |
Mandible fracture | 1 | 9 | NS | – | – | – |
Frontal fracture | 3 | 9 | 5.4 (1.3–22.9)∗∗ | 5 | 7 | 21.7 (5.3–88.4)∗ |
Le Fort fracture | 1 | 3 | NS | 1 | 3 | NS |
Rib fracture | No rib fracture | Odds ratio (95% CI) | ||||
Orbit fracture | 2 | 85 | NS | |||
Nasal fracture | 2 | 46 | NS | |||
Zygoma fracture | 6 | 21 | 12.0 (3.1–46.0)∗ | |||
ZMC fracture | 4 | 11 | 10.9 (2.7–44.4)∗ | |||
Mandible fracture | 1 | 9 | NS | |||
Frontal fracture | 1 | 11 | NS | |||
Le Fort fracture | – | – | – |
Fracture location | No operative fixation (%) | Operative fixation (%) |
---|---|---|
Mandible | 3 (1.9%) | 7 (15.9%) |
Palate | 0 (0.0%) | 1 (2.3%) |
Zygoma | 21 (13.0%) | 6 (13.6%) |
ZMC | 11 (6.8%) | 4 (9.1%) |
Orbit | 72 (44.7%) | 15 (34.1%) |
NOE | 0 (0.0%) | 1 (2.3%) |
Nasal | 43 (26.7%) | 5 (11.4%) |
Frontal sinus | 10 (6.2%) | 2 (4.5%) |
Le Fort | 1 (0.6%) | 3 (6.8%) |
Concomitant injury | No operative fixation (%) | Operative fixation |
---|---|---|
Long bone fracture | 14 (20.6%) | 5 (38.5%) |
Cervical spine fracture | 15 (22.1%) | 0 (0.0%) |
Skull fracture | 12 (17.6%) | 2 (15.4%) |
Intracranial hemorrhage | 9 (13.2%) | 2 (15.4%) |
Rib fracture | 8 (11.8%) | 2 (15.4%) |
Ophthalmic injury | 3 (4.4%) | 1 (7.7%) |
Short bone fracture | 4 (5.9%) | 0 (0.0%) |
Pelvic fracture | 1 (1.5%) | 1 (7.7%) |
Thoracic spine fracture | 1 (1.5%) | 0 (0.0%) |
Lumbar spine fracture | 1 (1.5%) | 0 (0.0%) |
Patient | Fracture site | Indication for operative fixation |
---|---|---|
1 | Orbital floor | ORIF performed for displaced fractures Concomitant placement of subclavian line and periprosthetic distal femur replacement |
2 | Orbital floor | Pain with eye movements and diplopia Floor completely blown out Delayed repair (1 mo) |
3 | Orbital floor | Enophthalmos/hypoglobus Delayed repair (>1 mo) |
4 | Orbital floor | Blowout with retrobulbar hematoma and proptosis Repaired during initial admission |
5 | Orbital floor/lateral wall | Enophthalmos, restricted eye movements Delayed repair (>1 mo) |
6 | Orbital floor/medial wall | Blowout with 4-mm enophthalmos Delayed repair (1 mo) |
7 | Orbital floor/medial wall | Blowout with 5-mm enophthalmos Delayed repair (1 mo) |
8 | Maxillary alveolus | Removal of multiple teeth Required appropriate occlusion |
9 | Bilateral mandibular body | ORIF because unable to close reduce (edentulous patient) |
10 | Mandibular angle | ORIF because unable to close reduce (edentulous patient) |
11 | Parasymphysis Mandibular body | ORIF because unable to close reduce (edentulous patient) |
12 | Subcondylar Mandibular angle/ramus | ORIF because unable to close reduce (edentulous patient) |
13 | Subcondylar | Gunning splint/MMF (edentulous patient) |
14 | ZMC | ORIF when patient became symptomatic with trismus Delayed repair (1 mo) |
15 | ZMC orbital floor | ORIF during initial admission Symptomatic with diplopia and infraorbital nerve numbness 0.3 × 0.4 cm anterolateral floor defect extending into orbital rim |
16 | ZMC orbital floor Hemi Le Fort I | ORIF performed for refractory diplopia Delayed repair (1 mo) 2 × 1 cm floor defect |
17 | ZMC orbital floor (nondisplaced) | ORIF performed for displaced ZMC fracture |
18 | Le Fort I/II | ORIF performed for displaced fractures |
19 | Le Fort II/III, frontal sinus | ORIF performed because patient had open bite and free-floating maxilla CSF leak was discovered during frontal sinus repair and cranialization performed with pericranial flap and lumbar drain placed by neurosurgery |
20 | Bilateral nasal bone | Closed reduction with laceration repair |
21 | Nasal bone | Closed reduction with laceration repair Associated avulsion injury |
22 | Le Fort II (nondisplaced) Medial orbital wall Nasal bone Zygoma (nondisplaced) Bilateral mandibular condyles Mandibular symphysis | Closed reduction of mandibular fractures/MMF with teeth 8/9/10 extracted |
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Liu, F.C.; Halsey, J.N.; Oleck, N.C.; Lee, E.S.; Granick, M.S. Facial Fractures as a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies. Craniomaxillofac. Trauma Reconstr. 2019, 12, 45-53. https://doi.org/10.1055/s-0038-1642034
Liu FC, Halsey JN, Oleck NC, Lee ES, Granick MS. Facial Fractures as a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies. Craniomaxillofacial Trauma & Reconstruction. 2019; 12(1):45-53. https://doi.org/10.1055/s-0038-1642034
Chicago/Turabian StyleLiu, Farrah C., Jordan N. Halsey, Nicholas C. Oleck, Edward S. Lee, and Mark S. Granick. 2019. "Facial Fractures as a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies" Craniomaxillofacial Trauma & Reconstruction 12, no. 1: 45-53. https://doi.org/10.1055/s-0038-1642034
APA StyleLiu, F. C., Halsey, J. N., Oleck, N. C., Lee, E. S., & Granick, M. S. (2019). Facial Fractures as a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies. Craniomaxillofacial Trauma & Reconstruction, 12(1), 45-53. https://doi.org/10.1055/s-0038-1642034