National Characteristics and Patterns of Facial Fractures in the Elderly Population

Abstract

BACKGROUND: Given the increasing elderly population in the United States, the number of people seeking care for trauma injuries is expected to rise.1 However, nationwide studies on the epidemiological profile of elderly facial fractures remain sparse.2 Our retrospective study presents the characteristics and patterns of elderly facial fractures on a national scale. METHODS: Characteristics of facial fractures among nonelderly adults (64 years and younger) and elderly population (65 years and older) were examined using the 2016 American College of Surgeons—Trauma Quality Improvement Project (ACS—TQIP) database. All elderly patients were further subdivided into 3 age groups: 65–74 years old, 75–84 years old, and 85 years and older. This study examined types of facial fracture patterns, mechanisms of injury, and demographic data. Further subgroup analysis of the different fracture types was also conducted, examining the same variables. RESULTS: Three thousand four hundred fifteen (3.3%) elderly patients presented with facial fractures out of 104,183 elderly trauma patients. The majority of facial fractures in the older 85 and over group (60.7%) were experienced by females, whereas only 19.5% of fractures in the younger adult group (<65 years old) were experienced by women. The most common mechanism of injury in the elderly was falls, with motor vehicle transport being the most common mechanism of injury in adults. The most common type of facial fractures among the elderly and nonelderly were nasal fractures (P = 0.04). Elderly patients presented with significantly fewer zygoma and mandibular fractures when compared to nonelderly patients (P = 0.001 and P = 0.001, respectively), while showing significantly more maxillary/malar and orbital bone fractures. Fractures suffered by elderly patients were less severe compared to younger adults (P = 0.001) as reflected by the Injury Severity Score. Elderly patients experienced less operative management (4.3%–8.2%) compared to younger adults (15.6%), with the rate of operative management decreasing with increasing age of patients. In addition, mortality rates were higher in the elderly patients when compared to their younger counterparts (P = 0.001). Elderly patients were also less likely to present with associated skull fractures, but more likely to present with TBI. CONCLUSIONS: Elderly patients presented with different causes of injury, distribution of fractures, comorbidities, and rates of operative management as well as mortality compared to their younger adult counterparts. REFERENCES: 1. Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health. 2017;142:64–69. 2. Shumate R, Portnof J, Anundson M, et al. Recommendations for care of geriatric maxillofacial trauma patients following a retrospective 10-year multicenter review. J Oral Maxillofac Surg. 2018;76:1931–1936.