How to prevent overlooking cervical spine injuries: pitfalls in spinal diagnostics

Occurrence and types of associated injuries in patients with fractures of the facial bones

PURPOSE

To identify the occurrence, types, and severity of associated injuries outside the facial region among patients diagnosed with facial fractures, and to analyze whether there are any factors related to associated injuries.

MATERIALS AND METHODS

This was a cross-sectional study of 401 patients diagnosed with facial fractures during the 2-year period from 2003 to 2004.

RESULTS

Associated injuries were observed in 101 patients (25.2%). The most common type of injury was a limb injury (13.5%), followed by brain (11.0%), chest (5.5%), spine (2.7%), and abdominal (0.8%) injuries. Multiple associated injuries were observed in 10% and polytrauma in 7.5%. The mortality rate was 0.2%. The occurrence of associated injury correlated significantly with trauma mechanism and fracture type; high-speed accidents and severe facial fractures were significant predictors of associated injury.

CONCLUSIONS

Associated injuries are frequent among patients who have sustained facial fractures. The results underscore the importance of multiprofessional collaboration in diagnosis and sequencing of treatment, but also the importance of arranging appropriate clinical rotations for maxillofacial residents in training.

[Traumatology of the spine]

Spinal trauma poses considerable threats to survival and quality of life. Especially cervical spine injuries are often associated with neurologic deficits. A thorough diagnostic pathway, often including computed tomography with sagittal reconstruction, is mandatory to evaluate the extent and consequences of spinal trauma. Every treatment must aim to restore stability and prevent secondary neurologic deterioration. Compression fractures usually can be treated successfully with conservative treatment, while burst fractures usually, and flexion/distraction injuries, and fracture-dislocation generally require internal stabilization. Injuries of the upper cervical spine can be treated conservatively or operatively, depending on the degree of instability. In the lower cervical spine, most injuries require internal fixation.