Abstract: Facial Fractures As a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies

Abstract

INTRODUCTION: Mechanical falls are a common cause of facial trauma in the elderly. It has been shown that the likelihood of sustaining a facial fracture due to a fall increases with age following infancy. While craniomaxillofacial fractures are most common during the first three decades of life, elderly patients more frequently require lengthy hospital stays and have shown increased surgical complication rates when compared to younger patients. The goal of this study was to examine facial fractures secondary to mechanical falls in the elderly in order to analyze mechanism of injury, comorbidities, and fracture management. METHODS: A retrospective review of all facial fractures as a result of falls in the elderly population in a level 1 trauma center in an urban environment was performed for the years 2002 to 2012. Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. RESULTS: During the time period examined, 139 patients greater than 60 years of age that sustained a fracture of the facial skeleton as the result of a fall were identified. The average age was 75.7, with no gender predominance. There were a total of 205 fractures recorded. The most common fractures were those of the orbit (42.0%), nasal bone (23.4%), zygoma (13.2%), and zygomaticomaxillary complex (7.32%). The average Glasgow Coma Scale on arrival was 12.8. Uncontrolled hemorrhage was noted on presentation in 5 patients. Twenty-one patients were intubated on, or prior to, arrival and 44 required a surgical airway. The most common concomitant injury was long bone fracture (23.5%), followed by cervical spine fracture (18.5%), skull fracture (17.3%), intracerebral hemorrhage (17.3%), and rib fracture (17.3%). Of the 114 patients admitted to the hospital, 53 were admitted to an intensive care setting. The average length of stay was 8.97 days. Sixteen patients expired. Surgical management of fractures was required in 47 of the 139 patients. CONCLUSION: Facial fractures as a result of falls in the geriatric population represent an increasing number of cases in clinical practice as life expectancy steadily rises. These patients require a specific standard of treatment since they are more susceptible to nosocomial infections, as well as have higher complication rates and longer recovery time. Concomitant injuries such as cervical spine and pelvic fractures can greatly increase risk of mortality.