Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries.
OBJECTIVE
The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury.


METHODS
In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population.


RESULTS
The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected.


CONCLUSIONS
In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms.


METHODS
Level III.
Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany.
Volker
V
Krutsch
Department of Trauma Surgery, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany.
Markus
M
Gesslein
Clinic for Paediatric Surgery, Clinic St. Hedwig, Regensburg, Germany.
Oliver
O
Loose
Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Johannes
J
Weber
Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Michael
M
Nerlich
Clinic Wolfsburg, Department of Trauma Surgery, Wolfsburg, Germany.
Axel
A
Gaensslen
Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany.
Viktor
V
Bonkowsky
Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. werner.krutsch@ukr.de.
Werner
W
Krutsch
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000150:complications / Q000503:physiopathology*; D001924:Brain Concussion / Q000209:etiology / Q000503:physiopathology; D000070642:Brain Injuries, Traumatic / Q000209:etiology / Q000503:physiopathology*; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D005538:Football / Q000293:injuries*; D050723:Fractures, Bone / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000068958:Return to Sport; D012307:Risk Factors; D055815:Young Adult
Concussion; Football; Midfacial fracture; Prevention; Return-to-play; Soccer