title: C-spine injury and mandibular fractures: lifesaver broken in two spots.
abstract: Trauma is a leading cause of injury and mortality and may involve mandibular fractures and cervical spine injuries. Manipulation of the spine during trauma protocols and operative treatment has the potential to cause serious spinal cord injuries. The purpose of this study was to identify risk factors associated with cervical spine injury (CSI) in patients with mandibular fractures.
  
  
  
  The National Trauma Databank (2007-2010) was used to identify patients with mandibular fractures.
  
  
  
  A total of 59,028 patients were identified and separated into adult and pediatric cohorts. There were 50,711 adults (86%) and 8317 children (14%). There were statistically significant lower rates of associated CSI in pediatric patients than adults (3.5% versus 7.3%, P < 0.01). Predictors of associated CSI in mandible fractures for both adults and children were older age, lower Glasgow Coma Scale, thoracic injuries, firearm or motor vehicle accident mechanisms, and symphyseal fractures. In the pediatric cohort, body, ramus, and subcondylar fractures were significantly associated with CSI. In adults, female gender, and upper extremity, abdominopelvic, and head injuries were also significantly associated with CSI.
  
  
  
  Multiple mandibular fractures were inversely correlated with CSI. One possibility is that energy dissipation in the mandible with multiple fractures is protective of the C-spine leading to fewer fractures. Children and adults had different associations in the pattern of mandible fractures concomitant with CSI. This has implications in management, imaging, and workup of trauma patients.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, R.L. Roudebush VA Medical Center, Indianapolis, Indiana.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Soleimani
authors.affiliation: Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Tyler A
authors.initials: TA
authors.lastname: Evans
authors.affiliation: Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Sarah I
authors.initials: SI
authors.lastname: Fernandez
authors.affiliation: Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Leigh
authors.initials: L
authors.lastname: Spera
authors.affiliation: Department of Oromaxillofacial Surgery, Indiana School of Dentistry, Indianapolis, Indiana.
authors.forename: Carrie
authors.initials: C
authors.lastname: Klene
authors.affiliation: Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.affiliation: Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, R.L. Roudebush VA Medical Center, Indianapolis, Indiana. Electronic address: stholpad@iupui.edu.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Tholpady
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008337:Mandibular Fractures / Q000150:complications*; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
keywords: C spine; Cervical spine; Facial fracture; Mandibular fracture; Spinal trauma