Facial fractures in the elderly: epidemiology, clinical characteristics, and management

Abstract

With an ageing population, the elderly will increasingly represent a growing subgroup of trauma. A high-risk group with multiple comorbidities, decreased physiological reserves and frailty, this contributes to the complexity of management in facial trauma. Falls represent the most common presentation for facial-related injuries, but there are variations amongst gender that is important to aid diagnosis, management, and treatment plans. Our aim is to identify epidemiological trends of facial fractures in the elderly, understand differences amongst gender and elderly age groups, and the impact this has on clinical outcomes and management. A retrospective review was conducted from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. All facial fractures of the elderly, 65 years and above, that attended or were referred to the unit were included in this study. Three hundred fifty-five elderly patients presented with a facial fracture with falls (82.5%) as the most common mechanism of injury. The orbitozygomatic fracture was the most common type of facial fracture with 48.7% of the cohort sustaining an associated injury. There were differences between men and women for age, age groups, socioeconomic status, season, alcohol, mechanism of injury, and facial fractures (p<0.05). The 75–85 and 85+ age groups were 2.4 and 15.1 times more likely to have a fall-related facial fracture than the 65–75 age group, and less likely to have surgery (p<0.05). Associated injuries were independently associated with increased length of stay (p<0.001). Geriatric men and women have differences in facial fractures and aetiologies, but an overall non operative approach was favoured on a balanced approach of comorbidities, function, and quality of life. Elderly patients are complex with associated injuries and comorbidities, and they often require interdisciplinary care across fields of medicine and surgery to minimize their length of stay and yield good outcomes. Level of evidence: Level III, therapeutic; diagnostic; risk/prognostic study.