Trending: Facial Fractures

Many people report odd accidents when questioned about broken facial bones—walking into a door, hitting road signs or parked cars while bicycling, bumping into a hard object while texting. Facial fractures are a frequent cause for emergency department (ED) visits, costing the US economy about $1 billion every year. These fractures can occur due to motor vehicle accidents, sports injuries, person-to-person violence, or falls. Identifying trends could help ED personnel and surgeons anticipate common problems. Researchers from Wayne State University in Detroit, MI have tracked trends in facial fractures from 1990 to the present day. Their article appears in the January 2015 issue of the Journal of Craniofacial Surgery.

Using the National Inpatient Survey and data from nonpediatric inpatient and outpatient facilities of the Detroit Medical Center, the researchers examined the incidence of facial fractures from 1990 to 2011. They weighted national inpatient estimates from 1993 to 2010, and grouped fracture sites.

They identified 2000 as a pivotal change year. Total fractures decreased significantly during the 1990s, but began to increase in 2000. The rate of fracture repairs decreased in the 1990s, but has held steady since 2000.

The authors note that more fractures could be expected to correlate with more repairs. This particular trend—more fractures but a similar number of repairs—suggests that craniofacial experts are employing non-operative fracture repair more often. They also note that EDs are more likely to use CT scanning, which may identify less severe fractures and may also help identify fractures that do not need repair more accurately.

Motor vehicle—related injuries decreased during the entire study period, probably because of increased seatbelt use and improved safety features in modern cars (although they indicate airbags alone are not protective). The national aggravated assault rate has also fallen steadily, but increased slightly in Detroit.

The researchers indicate that the lack of data from ambulatory settings is a limitation, and that they were unable to track fractures related to less-frequent causes because the numbers are so small. Regardless, they were able to document significant changes and identify potential causes.