title: Le Fort II fractures are associated with death: a comparison of simple and complex midface fractures.
abstract: OBJECTIVE
  To investigate whether complex midface fractures have a greater association with death and intracranial injury than simple midface fractures.
  
  
  METHODS
  A retrospective chart review was performed for patients with blunt-mechanism midface fractures who had presented to an urban trauma center from 1998 to 2010. The survival and intracranial injury status was evaluated for patients with simple and complex midface fractures, including Le Fort, naso-orbitoethmoid, and/or zygomaticomaxillary fractures. Intracranial injury included hemorrhage and brainstem injury. Patients with upper face fractures were excluded to minimize confounding. Adjusted relative risk estimates were obtained using multivariate regression analysis.
  
  
  RESULTS
  Of 3,291 patients with midface fractures, 213 (6.3%) died and 693 (21.3%) had an intracranial injury. The cumulative mortality reached 11.6% in patients with complex midface fractures and 5.1% in those with simple midface fractures (P < .001). Patients with complex midface fractures were 57% more likely to die (relative risk = 1.57; P < .005). Specifically, Le Fort II fractures independently conferred a 94% increased risk of death (relative risk = 1.94; P < .01), but Le Fort I and III fractures were not significantly associated with death. Among patients presenting without neurologic impairment, those with Le Fort II and III fractures remained 2.88-fold (P < .01) and 2.54-fold (P < .001) more likely to have an underlying intracranial injury, respectively.
  
  
  CONCLUSIONS
  Le Fort II fractures are associated with increased mortality. Furthermore, Le Fort II and III fractures are associated with serious intracranial injury, even in the absence of alterations in consciousness. These patients should be monitored with heightened vigilance and followed up closely during hospitalization, regardless of the presenting clinical findings.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Bellamy
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: Sashank K
authors.initials: SK
authors.lastname: Reddy
authors.forename: José M
authors.initials: JM
authors.lastname: Flores
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D001930:Brain Injuries / Q000401:mortality; D001933:Brain Stem / Q000293:injuries; D002543:Cerebral Hemorrhage / Q000401:mortality; D015331:Cohort Studies; D005004:Ethmoid Bone / Q000293:injuries; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008440:Maxillary Fractures / Q000145:classification / Q000401:mortality*; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000401:mortality; D012189:Retrospective Studies; D012887:Skull Fractures / Q000145:classification / Q000401:mortality*; D015996:Survival Rate; D014754:Violence / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000401:mortality; D055815:Young Adult; D015051:Zygomatic Fractures / Q000401:mortality