title: Analysis of radiographically confirmed blunt-mechanism facial fractures.
abstract: Facial fractures resulting from blunt-mechanism trauma, although common, have been infrequently evaluated in large studies that do not include confirmation of fractures based on author review of available patient radiographic studies. An 8-year review (1998-2006) of the R Adams Cowley Shock Trauma Registry was performed with institutional review board approval. Patients diagnosed with blunt-mechanism facial fractures were identified by the International Classification of Diseases, Ninth Revision (ICD-9) codes and their facial fractures confirmed by author review of computed tomographic scans. Individual fractures were classified and grouped according to the facial thirds. Intra- and interreader variability was calculated, and confirmed fracture patterns were compared to fracture patterns listed by ICD-9 codes. Concomitant injuries and demographic data were additionally evaluated. Four thousand three hundred ninety-eight patients with 8127 fractures were identified. Intra- and interreader variability was 2% and 7%, respectively. ICD-9 coding misdiagnosed 12.5% of all fractures. Eighty-two percent of patients sustained associated injuries, including basilar skull fractures (7.6%) and cervical spine fractures (6.6%). 1.1% had at least one fracture in each facial third (panfacial fracture pattern). Significant relationships were found between demographic parameters, concomitant injuries, specific fractures, and fracture patterns. Studies investigating facial fractures should report fracture patterns confirmed by author review of available radiographic imaging. Large retrospective data sets containing confirmed fractures and capable of addressing rare fracture patterns can be compiled with low inter- and intrauser variability, and are useful for generating mechanistic hypotheses suitable for evaluation in prospective series or by directed biomechanical studies.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, and †Center for Surgical Trials & Outcomes Research (CSTOR), Department of Surgery, Johns Hopkins University, Baltimore, MD; ‡Division of Plastic Surgery, Duke University Medical Center, Durham, NC; and §Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
authors.forename: Marta M
authors.initials: MM
authors.lastname: Gilson
authors.forename: Suhail K
authors.initials: SK
authors.lastname: Mithani
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kelamis
authors.forename: Michael R
authors.initials: MR
authors.lastname: Christy
authors.forename: Paul N
authors.initials: PN
authors.lastname: Manson
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D005624:Frontal Bone / Q000293:injuries; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008337:Mandibular Fractures / Q000453:epidemiology; D008396:Maryland / Q000453:epidemiology; D008440:Maxillary Fractures / Q000453:epidemiology; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016103:Spinal Fractures / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult; D015051:Zygomatic Fractures / Q000453:epidemiology