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Non-fatal Sport Related Craniofacial Fractures: Characteristics, Mechanisms, and Demographic Data in the Pediatric Population
Zoe M. MacIsaac, M.D.1, Hebist Berhane, BS1, James J. Cray, Jr., PhD2, Nichole Zuckerbraun, M.D.1, Joseph E. Losee, M.D.1, Lorelei J. Grunwaldt, M.D.1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2Georgia Health Sciences University, Augusta, GA, USA.
BACKGROUND: There are few reports on sport related craniofacial fracture injuries in the pediatric population. The majority of patients with craniofacial injuries tend to be adults, and most studies that have dealt with children’s sport injuries do not focus specifically on craniofacial fractures. The goal of this study was to provide perspective on sport related craniofacial injuries in the pediatric population at a major tertiary care hospital.
METHODS:A retrospective review was conducted for all children between the ages of 0 and 18 years with craniofacial fractures who were seen in the Emergency Department at a major Children Hospital between 2000 and 2005. Fracture characteristics, mechanism of injury, and demographic data were obtained for each patient.
RESULTS: Of the 1578 patients in the cohort, 167 craniofacial fractures were identified that were due to sport related trauma (10.58%). After being seen in the Emergency Department, 80 patients were hospitalized (45.5%), of whom 12 were admitted to the ICU (15.0%). The average minimum Glasgow Coma Scale Score was 14.7 (range 3-15). Fifty-two patients were managed surgically (31.1%).
There was a significant gender discrepancy; 135 of the sport related craniofacial injuries were boys (80.8%) and 32 were girls (19.2%). Peak incidence of sport related injuries occurred between the ages of 13-15 years (40.7%). Nasal fractures (35.9%), orbital fractures (33.5%) and skull fractures (30.5%) were most common, while fractures of the maxilla (12.6%), mandible (7.2%), zygomaticomaxillary complex (4.2%) and naso-orbital ethmoid complex (1.2%) were observed less frequently. Baseball and softball were most frequently associated with the craniofacial injuries (44.3%), while basketball (7.2%) and football (3.0%) were associated with fewer injuries. Several sports were correlated with specific fracture patterns: Soccer was correlated with dento-alveolar and maxillary trauma (r=0.171, p=0.031; r=0.193, p=0.015, respectively); skateboarding was correlated with dental crown fracture and skull trauma (r=0.164, p=0.039; r=0.273, p<0.001, respectively); horseback riding was correlated with skull trauma (r=0.158, p=0.047). The most common mechanisms of injury were being hit by a ball (34.1%) and collision with others (28.1%). Helmet use was surprising low during several sports activities: skateboarding, 92.9% without helmet; skiing/snowboarding, 100% without helmet. Only 25% of horseback riders did not wear a helmet.
CONCLUSIONS: The data presented increases knowledge regarding an infrequently reported patient population: pediatric sports-related craniofacial fractures. Nasal Fractures and skull fractures were the most commonly associated fractures. Overall, few craniofacial fractures were associated with major neurological trauma, as determined by Glasgow Coma Scale, while most craniofacial fractures were managed non-surgically. Several sports were associated with obvious trends, such as lack of helmet use, and may have otherwise been preventable. Overall, most fractures were related to baseball and softball injuries with the mechanism being contact with the ball.
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