title: Do contemporary temporal bone fracture classification systems reflect concurrent intracranial and cervical spine injuries?
abstract: OBJECTIVE
  Temporal bone fractures (TBFs) are a frequent manifestation of head trauma. We investigated the prevalence of concurrent intracranial injuries (ICIs) and cervical spine injuries (CSIs) in a series of patients with TBFs and attempted to identify significant associations between current TBF classification systems and either ICI or CSI.
  
  
  METHODS
  Retrospective case series with chart review.
  
  
  METHODS
  The records of all patients ≥18 years of age diagnosed with a basilar skull fracture, including TBF, at a level I trauma center from 2004 to 2009 were reviewed. Patient demographics, mechanism of injury, and Glasgow Coma Scale (GCS) scores were collected. Imaging studies were reviewed to classify TBF using the traditional longitudinal-transverse-mixed and otic capsule-sparing versus -involving systems and identify concurrent ICI and CSI.
  
  
  RESULTS
  Of 1,279 patients, 202 (15.8%) met inclusion criteria. There were 160 (79.2%) males. Sixteen (7.9%) patients had bilateral TBFs. Falls (n = 66, 32.7%) represented the most common mechanism for TBF. Longitudinal (n = 96, 44.0%) and otic capsule-sparing (n = 209, 95.9%) fractures were the most prevalent subtypes. There were 184 (91.1%) patients who sustained ICI and 18 (8.9%) who demonstrated CSI. Longitudinal, transverse, mixed, otic capsule-sparing, or otic capsule-involving TBF subtypes had no statistically significant associations with mechanism of injury, GCS score, or concomitant ICI or CSI.
  
  
  CONCLUSIONS
  More than 90% of patients sustaining TBF presented with concomitant ICI, and 9% sustained CSI. Current TBF classification systems do not correlate with these outcomes. A more sophisticated, multidisciplinary classification system encompassing radiographic and clinical findings may better predict neurologic, neuro-otologic, and skull base complications.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Sun
authors.forename: Nael M
authors.initials: NM
authors.lastname: Shoman
authors.forename: Ravi N
authors.initials: RN
authors.lastname: Samy
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Cornelius
authors.forename: Bernadette L
authors.initials: BL
authors.lastname: Koch
authors.forename: Myles L
authors.initials: ML
authors.lastname: Pensak
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis*; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis*; D012189:Retrospective Studies; D012887:Skull Fractures / Q000145:classification* / Q000175:diagnosis*; D013701:Temporal Bone