Time to wound closure in facial soft tissue injuries following road traffic accidents

The 6-hour (6-h) time to wound closure was a controversial issue as studies have shown that time was not a substantial factor. Wounds in the face are often considered to have a lower infection risk. Despite this, the cause of injury was not extensively discussed in relation to this context. The primary objective was to investigate the association between the 6-h time to wound closure and wound complications following emergency management of facial soft tissue injuries (STIs). Additionally, the secondary objective was to explore other factors contributing to wound complications. A retrospective record review was conducted in our hospital in Kuala Lumpur, Malaysia, from 1 January 2017 to 31 December 2021. Medical records of patients with facial STIs due to road traffic accidents were included. Simple random sampling was used to select records meeting inclusion criteria. Data on demographic, injury, and treatment characteristics were collected using a standardized proforma. Descriptive, univariate and multivariate analyses were performed, including chi-square tests and binary logistic regression. A total of 295 patient records were included, with most patients being males (77.3%) and of Malay ethnicity (54.9%). The median age was 31.0 years. Majority of patients were treated within 6 h of injury (93.9%). Complications were documented in 6.1% of cases, including wound dehiscence and infection. Multivariate analysis revealed a significant association between 6-h time to closure and wound complications (OR: 7.53, 95% CI: 1.90-29.81, p = 0.004). Grade of surgeon on duty (OR: 4.61, 95% CI: 1.25-16.95, p = 0.02) and diabetes mellitus (OR: 6.12, 95% CI: 1.23-30.38, p = 0.03) were also shown to have a statistically significant association with wound complications. A 6-h time to wound closure, grade of surgeon on duty and diabetes mellitus were three major factors involved in facial wound complications following road traffic accidents.

Effect of Delay of Care for Patients with Craniomaxillofacial Trauma in Rwanda

Objectives

Craniomaxillofacial (CMF) trauma represents a significant proportion of global surgical disease burden, disproportionally affecting low- and middle-income countries where care is often delayed. We investigated risk factors for delays to care for patients with CMF trauma presenting to the highest-volume trauma hospital in Rwanda and the impact on complication rates.

Study Design

This prospective cohort study comprised all patients with CMF trauma presenting to the University Teaching Hospital of Kigali, Rwanda, between June 1 and October 1, 2020.

Setting

Urban referral center in resource-limited setting.

Methods

Epidemiologic data were collected, and logistic regression analysis was undertaken to explore risk factors for delays in care and complications.

Results

Fifty-four patients (94.4% men) met criteria for inclusion. The mean age was 30 years. A majority of patients presented from a rural setting (n = 34, 63%); the most common cause of trauma was motor vehicle accident (n = 18, 33%); and the most common injury was mandibular fracture (n = 28, 35%). An overall 78% of patients had delayed treatment of the fracture after arrival to the hospital, and 81% of these patients experienced a complication (n = 34, P = .03). Delay in treatment was associated with 4-times greater likelihood of complication (odds ratio, 4.25 [95% CI, 1.08-16.70]; P = .038).

Conclusion

Delay in treatment of CMF traumatic injuries correlates with higher rates of complications. Delays most commonly resulted from a lack of surgeon and/or operating room availability or were related to transfers from rural districts. Expansion of the CMF trauma surgical workforce, increased operative capacity, and coordinated transfer care efforts may improve trauma care.

Sequencing of Fixation in Panfacial Fracture: A Systematic Review

Objective

In panfacial fracture management, the controversy still exists in the sequencing of fixation. The purpose of this systematic review is to establish the best sequence pattern which assists in achieving definite facial width, vertical height and anteroposterior projection.

Methods

The review was conducted according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Two independent authors performed a comprehensive search of the PUBMED, EBSCO, J-Gate, SCOPUS and NDH for articles published up until December 2018. Sequence of fixation, timing of intervention, outcome, follow-up period and complications were evaluated for patients with panfacial fracture.

Results

In total, 202 articles were identified from the databases. After screening and full text analysis, 25 studies were included in this systematic review. Nineteen studies reported bottom-to-top sequence and two studies reported top-to-bottom approach. However, four studies reported both the approaches. The follow-up period ranges from 3 weeks to 4 years.

Conclusion

Based on the literature support and evidence, good and satisfactory outcome achieved in "Bottom-top and outside-in" sequence when compared with other sequence pattern. Early repair of panfacial fracture is advised for proper reduction and fixation, but can be delayed in accompanying life-threatening injuries. Complications are perceptible in all the sequences; it can be avoided by definitive treatment planning and stepwise management.

Treatment of Facial Fractures at a Level 1 Trauma Center: Do Medicaid and Non-Medicaid Enrollees Receive the Same Care?

BACKGROUND

Timing of surgical treatment of facial fractures may vary with the patient age, injury type, and presence of polytrauma. Previous studies using national data sets have suggested that trauma patients with government insurance experience fewer operations, longer length of hospital stay (LOS), and worse outcomes compared with privately insured patients. The objective of this study is to compare treatment of facial fractures in patients with and without Medicaid insurance (excluding Medicare).

METHODS

All adults with mandibular, orbital, and midface fractures at a Level 1 Trauma Center between 2009 and 2018 were included. Statistical analyses were performed to assess the differences in the frequency of surgery, time to surgery (TTS), LOS, and mortality based on insurance type.

RESULTS

The sample included 1541 patients with facial fractures (mandible, midface, orbital), of whom 78.8% were male, and 13.1% (208) were enrolled in Medicaid. Mechanism of injury was predominantly assault for Medicaid enrollees and falls or motor vehicle accidents for non-Medicaid enrollees (P < 0.001). Patients with mandible and midface fractures underwent similar rates of surgical repair. Medicaid enrollees with orbital fractures underwent less frequent surgery for facial fractures (24.8% versus 34.7%, P = 0.0443) and had higher rates of alcohol and drug intoxication compared with non-Medicaid enrollees (42.8% versus 31.6%, P = 0.008). TTS, LOS, and mortality were similar in both groups with facial fractures.

CONCLUSIONS

Overall, the treatment of facial fractures was similar regardless of the insurance type, but Medicaid enrollees with orbital fractures experienced less frequent surgery for facial fractures. Further studies are needed to identify specific socioeconomic and geographic factors contributing to these disparities in care.

Comparison of Maxillofacial Trauma Patterns in the Urban Versus Suburban Environment: A Pilot Study

Introduction

Assault appears to be the most frequent cause of facial fractures in certain urban trauma centers, possibly due to the ease of acquiring weapons and increasingly aggressive behavior. The objectives of this study were to identify specific demographic, socioeconomic, maxillofacial fracture, and assault patterns in urban versus suburban communities.

Methods

A retrospective chart review of patients who sustained maxillofacial fractures from August 2014 through August 2016 at one urban campus, Einstein Medical Center, Philadelphia, and two suburban campuses, Einstein Medical Center Montgomery and Elkins Park. The χ² testing was used to compare the categorical variables between the 2 groups.

Results

A total of 259 maxillofacial trauma patients were identified, with 204 (79%) in the urban and 55 (21%) in the suburban environment. Patients in the urban population were more likely to be African American (70% vs 33%) and Hispanic (15% vs 6%) but less likely to be Caucasian (12% vs 55%, P < .0001). Urban patients were more likely to be single (70% vs 47%, P < .01), unemployed (64% vs 44%, P < .001), and receive Medicaid coverage (58% vs 26%, P < .001). Urban patients were more likely to be victims of assault (63% vs 44%), whereas suburban patients were more likely to sustain accidental injuries (16% vs 2%, P < .0001). Urban victims were more likely to be assaulted with an object (30% vs 12%) or gun (7% vs 0%, P = .05).

Conclusion

Maxillofacial trauma patterns were shown to be significantly different in the urban versus suburban environment.

Comparing Urban Maxillofacial Trauma Patterns to the National Trauma Data Bank©

OBJECTIVES

We aimed to determine whether certain maxillofacial fracture patterns and injury mechanisms were more prevalent in an urban environment. In addition, we aimed to determine if maxillofacial trauma incidence correlated with income.

METHODS

Data was collected from Einstein Healthcare Network and Temple University Health System. These data were compared to the 2016 National Trauma Data Bank© (NTDB©) using chi-square analysis. Multivariate analysis was used to identify correlations between demographic variables and fracture patterns. Sociodemographic data was further characterized utilizing neighborhood mapping.

RESULTS

A total of 252 patients from our urban campuses and 14 447 patients from the NTDB© were identified with facial fractures. Maxillofacial trauma patients in the urban population were more likely to be minorities and less likely to be Caucasian compared to the NTDB© (P < .001). Patients in the urban setting were more likely to sustain mandibular and orbital fractures, and less likely to sustain maxillary fractures and multiple fractures (P < .001). Urban maxillofacial trauma patients were more likely to sustain assault and sporting injuries, and less likely to sustain injuries from motor vehicle accidents and self-harm (P < .001).

CONCLUSIONS

Maxillofacial trauma patterns and injury mechanisms were shown to be significantly different in an urban environment as compared to national data.

Through the ages-Aetiological changes in maxillofacial trauma

AIMS

The number of patients suffering maxillofacial trauma remains constant although the affected patients become older. The aim of this study was to illuminate the patterns of maxillofacial fractures in a University Medical Centre and to analyse potential changes in patient population and treatment methods during a 5-year period.

MATERIALS AND METHODS

In a retrospective analysis, the records of 573 patients with maxillofacial fractures treated in a level one trauma centre from January 2010 to December 2014 were analysed with regard to gender, age, date and time of hospitalization as well as discharge, aetiology, type of fracture, surgery details, complications and further injuries. Causes were subdivided into assaults, falls, epileptic seizure, work-related, traffic accident by car or bicycle, sport-associated or others (eg caused by explosions, horse kicks or unknown).

RESULTS

The most common causes for fractures were assaults (28.8%; n = 165), followed by falls (23.9%; n = 137), although falls became the main reason for maxillofacial fractures in 2013 and 2014. The mean age for patients suffering from facial fractures due to falls was significantly higher compared to those injured by other causes. Most commonly, fractures of the zygomatico-maxillary complex with or without orbital floor involvement were seen (31.6%; n = 291) followed by fractures of the mandible (20.6%; n = 190) and fractures of the nose (15.2%; n = 140). Most patients were treated surgically (89.5%; n = 513) even though an increase in non-surgical treatment was found over the examination period, especially in older patients.

CONCLUSIONS

Maxillofacial fractures are mostly seen in younger male patients. Assaults were the main pattern of injury during the whole examination period, although falls became the main cause in older patients over the last 2 years.