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Pediatric facial fractures: interpersonal violence as a mechanism of injury
Ian C. Hoppe, MD, Anthony M. Kordahi, BA, Edward S. Lee, MD, Mark S. Granick, MD.
Rutgers - New Jersey Medical School, Newark, NJ, USA.
BACKGROUND: Several of the most common causes of pediatric facial fractures are interpersonal violence and motor vehicle accidents. The presentation of fractures as a result of different etiologies varies dramatically and can have a direct impact on management. This study compares facial fractures in a pediatric population as a result of interpersonal violence to other mechanisms of injury.
METHODS: A retrospective review of all facial fractures at a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patients 18 years of age or younger were included. Patient demographics were collected, as well as location of fractures, concomitant injuries, services consulted, and surgical management strategies. Patients were placed into 2 groups, those sustaining an injury as a result of interpersonal violence and all others. A significance value of 5% was utilized.
RESULTS: During this time period, there were 3,147 facial fractures treated at our institution, 353 of which were in pediatric patients. Upon further review 68 patients were excluded due to insufficient data for analysis, leaving 285 patients for review. There were 124 (43.5%) patients identified as sustaining a fracture as a result of interpersonal violence. Those sustaining a fracture as a result of interpersonal violence were statistically (p < 0.05) more likely to be male and to have sustained a fracture of the mandible. The most common services consulted for this group of patients was plastic surgery and oral and maxillofacial surgery. This group of patients was statistically (p < 0.05) more likely to be admitted specifically for management of a facial fracture and statistically (p < 0.05) more likely to be treated operatively with rigid internal fixation. Those sustaining a fracture as a result of interpersonal violence were significantly less likely to have other systemic injuries such as spinal fractures, intracranial fractures, long bone fractures, and pelvic/thoracic fractures. This group was also more likely to undergo treatment via conservative means. In addition a significantly higher Glasgow Coma Scale (14.7 vs. 12.8) and age (16.0 vs. 12.8 years) and a significantly lower hospital length of stay (2.9 vs. 7.9 days) was observed in the group subjected to interpersonal violence.
CONCLUSIONS: Pediatric patients suffering facial facture as a result of interpersonal violence show a very distinctive pattern of presentation. The energy associated with the injury is likely directed directly at the craniofacial skeleton and therefore other organ systems are spared. This allows more directed fracture management resulting in a shorter hospital stay when necessitating admission. The findings of this study are important in that such a large proportion of the patients reviewed suffered interpersonal violence, more so than most other similar studies.
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