title: Post-traumatic morbidity is frequent in children with frontobasilar fractures.
abstract: OBJECTIVE
  Frontobasilar fractures are potentially life-threatening injuries also in pediatric populations, often due to associated intracranial trauma. This retrospective study was performed at a tertiary care university hospital to evaluate the management and outcome of pediatric frontobasilar fractures. The secondary aim was to re-evaluate the computerized tomography images to reveal all the skull base fracture sites predicting morbidity.
  
  
  METHODS
  A retrospective analysis of all the 20 consecutive pediatric patients diagnosed with and treated for a frontobasilar fracture at the Turku University Hospital, Turku, Finland during 1995-2010 was performed. The referral area of this tertiary care university hospital covers 750,000 inhabitants of whom approximately 20% are 18 years or younger.
  
  
  RESULTS
  The mean annual incidence of frontobasilar fractures was 1.1 per 100,000 children aged 18 years and under. A road traffic accident was the most common etiological factor. Other factors included being hit by a heavy object, falling from a height, and falling to the ground. The mean Glasgow Coma Scale score was 10 and loss of consciousness was initially detected in 15 (75%) patients in the emergency unit. Twelve (60%) patients had an intracranial injury, 17 (85%) had facial bone fractures, and 15 (75%) had a fracture of the anterior cranial base. The middle cranial fossa and sella were affected in five (25%) of the patients. There seem to be no long-term neuroendocrine sequelae following brain injury, not even when the sella or the hypophyseal area was affected. Twelve (60%) patients were treated operatively. One patient died after one week of intensive care treatment. Only four (20%) patients had no post-traumatic implications, eight (40%) suffered from various long-term sequelae, and five (25%) had permanent neurological or neuropsychological sequelae.
  
  
  CONCLUSIONS
  Frontobasilar fractures in childhood are rare and often associated with intracranial trauma and long-term morbidity. However, according to this study, 75% of the patients showed no permanent neurological or neuropsychological sequelae.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Finland. ulla.perheentupa@utu.fi
authors.forename: Ulla
authors.initials: U
authors.lastname: Perheentupa
authors.forename: Ilpo
authors.initials: I
authors.lastname: Kinnunen
authors.forename: Reidar
authors.initials: R
authors.lastname: Grénman
authors.forename: Kalle
authors.initials: K
authors.lastname: Aitasalo
authors.forename: Jari O
authors.initials: JO
authors.lastname: Karhu
authors.forename: Antti A
authors.initials: AA
authors.lastname: Mäkitie
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging / Q000293:injuries*; D020205:Skull Fracture, Basilar / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed