PEDIATRIC FACIAL FRACTURES: THE CURRENT DEMOGRAPHIC 200-2007
Joseph E. Losee, MD, FACS, Richard M. Saladino, MD, Joseph V. Madia, BS, Lisa Vecchione, DDS, Frederic W.B. Deleyiannis, MD, Gary M. DeCesare, MD, Sanjay Naran, BS.
Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Background/Purpose: Pediatric facial fractures can result in growth and developmental disturbances due to the fracture itself, rigid fixation of the fracture, and disruption of the growth centers in the pediatric facial skeleton. While previous inquiries have addressed the pathology and mechanisms of pediatric facial fractures, these studies have had limitations of selection bias inherent in the study populations analyzed by these efforts. Pediatric facial fractures are managed by multiple services and authors frequently exclude the patients of colleagues both within and outside their own specialties. The present study is designed to minimize selection bias in an effort to elucidate optimal strategies for the prevention and treatment of pediatric facial fractures and more accurately assess the incidence and characteristics of pediatric facial fractures, including those not requiring inpatient hospitalization or corrective surgery. It will also establish an ongoing pediatric facial fracture database and address the present literature’s paucity of long-term follow-up data and serve as the basis for a longitudinal examination of growth and development of the pediatric facial skeleton after fracture.
Methods: Review of paper charts and electronic medical record of all patients presenting to the emergency department of our center (a major urban children’s hospital) from 2000-2007 who were assigned an ICD-9 code indicative of facial fracture; currently, approximately 2000 patients will be included.
Results: Thus far we have reviewed 1224 patients, which has broken down demographically as such: 65.4% males, 34.6% females, 81.2% Caucasian, 13.4% African-American, 5.0% other ethnicities, with an average age of 8.2 years at injury. Sixty-nine point three percent of patients required hospital admission, 30.7% were discharged from the ED for outpatient follow-up. Twenty-three point four percent required corrective surgery. Eighteen patients died as a result of their injuries. Skull fractures made up 58.1%, along with 27.9% Orbital Fractures, 0.8% Naso-Orbital-Ethmoidal fractures, 12.0% Maxillary Fractures, 18.4% Nasal Fractures, and 14.7% Mandible Fractures. Regarding mechanism of injury, 43.3% fractures were caused by falls, 25.4% were caused by collisions, 7.5% by sporting/work equipment, 11.7% by blows by another human or animal, 3.8% by crush injury, 1.6% by projectile, and 6.3% by being struck by a motor vehicle. Twenty-one point two percent of fractures were sustained in motor vehicle accidents, 12.1% in bicycle wrecks, 4.8% in ATV wrecks, and 1.8% in motorcycle wrecks. Excluding isolated skull fractures, 81.7% of patients with a facial fracture suffered a neurologic injury, with 24% of patients with a facial fracture suffering an intracranial bleed. Twenty-six point five percent suffered an ophthalmalogic injury but only 2 patients were blinded. Soft tissue injuries were seen in 77.3% o facial fractures. Distressingly, African-American children are three times more likely to suffer a facial fracture due to assault than all other races.
Conclusions: The above mentioned statistics are just a slice of the total demographic information that will become available. Upon completion of the study, we will have comprehensive information on the occurrence and management of all pediatric facial fractures, enabling us to better treat patients and improve preventive and safety measures for all children.