Management of Facial Fractures in the Elderly Patient: Experience of the Orthognathic Surgery and Facial Trauma Clinic of the Gea GonzáLez Hospital

AbstractThis study aimed to define better the clinical presentation, fracture patterns, and features predictive of associated injuries and need for surgery in pediatric facial trauma patients in an urban setting. Charts of patients 18 years or younger with International Classification of Disease 9th and 10th revision (ICD-9/ICD-10) codes specific for facial fractures (excluding isolated nasal fractures) at NY-Presbyterian/Weill Cornell Medical Center between 2008 and 2017 were retrospectively reviewed. Of 204 patients, most were referred to the emergency department by a physician's office or self-presented. Children (age 0–6 years) were most likely to have been injured by falls, while more patients 7 to 12 years and 13 to 18 years were injured during sporting activities (p < 0.0001). Roughly half (50.5%) of the patients had a single fracture, and the likelihood of surgery increased with greater numbers of fractures. Older patients with either orbital or mandibular fractures were more likely to undergo surgery than younger ones (p = 0.0048 and p = 0.0053, respectively). Cranial bone fractures, CSF leaks, and intracranial injuries were more common in younger patients (p < 0.0001) than older patients and were more likely after high energy injuries; however, 16.2% of patients sustaining low energy injuries also sustained cranial bone, CSF leak, or intracranial injury. In an urban environment, significant pediatric facial fractures and associated injuries may occur after nonclassic low kinetic energy traumatic events. The age of the patient impacts both the injuries sustained and the treatment rendered. It is essential to maintain a high index of suspicion for associated injuries in all pediatric facial trauma patients.

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Epidemiology of Maxillo-Facial Trauma During COVID-19 Lockdown: Reports From the Hub Trauma Center in Milan

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520983119 ◽

2020 ◽

pp. 194338752098311

Author(s):

Gabriele Canzi ◽

Elena De Ponti ◽

Federica Corradi ◽

Roberto Bini ◽

Giorgio Novelli ◽

...

Keyword(s):

Interpersonal Violence ◽

Trauma Center ◽

Major Trauma ◽

Suicide Attempts ◽

Linear Trend ◽

Trauma Team ◽

Facial Trauma ◽

Facial Fractures ◽

Epidemiological Changes ◽

Systemic Symptoms

Study Design Retrospective study. Objective: Following SARS-CoV-2 pandemic break-out a lockdown period for the population and a reorganization of the Health System were needed. Hub-function Centers for time-dependent diseases were identified and Niguarda Hospital (Milan) was selected as main Regional Trauma Center. The purpose of our study is to report the experience of Niguarda Maxillofacial Trauma Team during this period, pointing out epidemiological changes in the presentation of trauma in comparison to the previous 3 years. Methods: Two hundred and sixteen patients were admitted to the Emergency Department from 8th March 2020 to 8th May 2020. One hundred and eighty-one had a diagnosis of Major Trauma and 36 had also facial fractures; 35 patients had isolated facial fractures. Data were compared to the activity during the same period in 2017-2019 and statistical analysis was carried out concerning demographic and clinical characteristics, trauma dynamics and positivity to COVID-19. Results: Cumulative curves of patients admitted because of Major Trauma describe a superimposable linear trend in years 2017-2019, while 2020 shows an increase from April 16th. Average age and number of more severe patients were higher than previous years. Epidemiological changes concerned road accidents, accidents involving pedestrians and cyclists, interpersonal violence, suicide attempts and domestic accidents. The incidence of facial fractures was confirmed through years and, according to its measured severity, 75% of patients required management. COVID-19 positivity without systemic symptoms didn’t influence the type of treatment. Conclusion: The COVID-19 lockdown offers a unique opportunity to study the reversal epidemiological effects on trauma.

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A Nationwide Study of Skiing and Snowboarding-Related Facial Trauma

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387521997237 ◽

2021 ◽

pp. 194338752199723 ◽

Cited By ~ 1

Author(s):

Thomas J. Sorenson ◽

Vedant Borad ◽

Warren Schubert

Keyword(s):

Surveillance System ◽

Pediatric Patients ◽

Facial Trauma ◽

Facial Fractures ◽

Facial Fracture ◽

Cold Winter ◽

Injury Surveillance System ◽

Weighted Estimates ◽

Patient Demographics ◽

The Us

Study Design: Retrospective descriptive observational study. Purpose: Skiing and snowboarding offers valuable opportunities for outdoor physical activity throughout the cold winter months, but these activities can result in substantial personally injury. This study aimed to analyze trends in skiing and snowboarding-related facial trauma epidemiology. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for facial trauma related to skiing and snowboarding treated in United States (US) emergency departments between 2010 and 2019. These data and weighted estimates were used to analyze patient demographics, injury location, and etiology. Results: A total of 361 skiing or snowboarding-related facial injuries were recorded. Lacerations were most common injury (165/361; 45.7%), and facial fractures occurred in 21.6% (78/261) of patients. The most common facial fracture locations are the nose (38/78; 48.7%), orbit (17/78; 21.8%), and mandible (15/78; 19.2%). Pediatric patients accounted for 52% (187/361) of these injuries and had higher rates of lacerations (51.9% vs 39.1%, P < 0.05) and hospital admission (4.8% vs 1.15%, P < 0.05) than adults. Adults had a higher rate of facial fracture (30% vs 13.9%, P < 0.001) than children. Conclusions: Skiing and snowboarding-related facial trauma is relatively uncommon in the US. In general, these injuries are largely decreasing, but facial fractures still occur not infrequently during these activities. Based on our data, we strongly urge helmet manufacturers to increase the availability of recreational snowsport helmets that include nose, orbit, and mandible protections, which could help to prevent many of these injuries.

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Creating a Safer Patient Room Environment: The Contribution of Patient Bed Height

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101163 ◽

2021 ◽

Vol 10 (1) ◽

pp. 180-184

Author(s):

Dorothy Taylor ◽

Janice Morse ◽

Andrew Merryweather

Keyword(s):

Elderly Patient ◽

Fall Risk ◽

The Elderly ◽

Lower Leg ◽

Patient Specific ◽

Leg Length ◽

Patient Room ◽

Patient Falls ◽

Sit To Stand ◽

Bed Height

Elderly patient falls are expensive and may cause serious harm. Studies have identified the sit-to-stand-and-walk (STSW) task as the task where the greatest number of elderly patient falls occur. There is a great need to identify the particular movement and environmental conditions that lead to these elderly patient falls. This study begins to address this gap by evaluating the elderly patient during self-selected hospital bed egress. Using an observed fall risk episode (FRE) as a fall proxy, statistically significant parameters were identified which include bed height, pausing prior to initiating gait, level of fall risk, and Stand phase. Low bed height was identified as the least safe bed height. Patient-specific bed height (PSBH) using the patient’s lower leg length (LLL) is recommended. In addition, suggested guidelines are presented for clinical application in setting PSBH without measuring the patient’s LLL.

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