The Northeastern Society of Plastic Surgeons

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Pediatric Facial Fractures Secondary to Falls - Injury Patterns and Management Strategies
Nicholas C. Oleck, BA, Thuy-My T. Le, BA, Farrah C. Liu, BS, Jordan N. Halsey, MD, Edward S. Lee, MD, Mark S. Granick, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.

PURPOSE: Falls are the leading cause of nonfatal injury in the pediatric population, resulting in numerous hospitalizations. Children may not have fully developed reflexive and balancing abilities, rendering them more susceptible to traumatic falls. Here the authors present their findings regarding pattern of injury and strategies for managing the immature nature of the pediatric facial skeleton.
METHODS: A retrospective chart review was performed of all facial fractures as a result of falls in the pediatric population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies.
RESULTS: During the time period examined, 50 patients were identified as less than 18 years of age or younger and having sustained a facial fracture as the result of a fall. The mean age was 7.9 (range 0 18) years, with a male predominance of 56.0%. There were a total of fifty-eight fractures identified on radiologic imaging via CT or X-ray. The most common fractures were those of the orbit (31.0%), mandible (29.3%), and nasal bone (8.6%). Mean Glasgow Coma Scale on arrival was 14.0 (range 3 15). Three patients were intubated on, or prior to, arrival to the trauma bay. The most common concomitant injuries were intracranial hemorrhage, long bone fractures, and cervical spine fractures. The mean operative time was 187.9 minutes. Surgery was required in 38 patients, while the others underwent closed reduction and soft tissue management. Most surgical patients underwent open reduction and internal fixation with titanium plates and screws. One patient required maxillomandibular fixation, and two required Medpor implants. The mean hospital length of stay was 3.6 (range 0 20) days. One patient expired.
CONCLUSION: Pediatric facial fractures require unique management, and are often accompanied by more life-threatening injuries. The authors hope this study can address a preventable issue in child safety, educate caregivers, and provide insight towards fracture management that fosters functional and aesthetic recovery.


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