Epidemiology of Craniomaxillofacial Fractures Over a 5-year Period at a Midwestern Level 1 Trauma Center Serving a Large Rural Population

Shreya Rangarajan; Ethan W Chen; Xuan-Mai Nguyen; Deepak Lakshmipathy; Knika Sethi; Jonathan Bailey

doi:10.1016/j.joms.2024.03.002

Epidemiology of Craniomaxillofacial Fractures Over a 5-year Period at a Midwestern Level 1 Trauma Center Serving a Large Rural Population

J Oral Maxillofac Surg. 2024 Mar 6:S0278-2391(24)00133-2. doi: 10.1016/j.joms.2024.03.002. Online ahead of print.

Authors

Shreya Rangarajan¹, Ethan W Chen², Xuan-Mai Nguyen³, Deepak Lakshmipathy³, Knika Sethi⁴, Jonathan Bailey⁵

Affiliations

¹ Medical Student, Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, IL. Electronic address: ssr8@illinois.edu.
² Radiology Resident, Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA.
³ Medical Student, Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, IL.
⁴ Oral and Maxillofacial Surgery Resident, Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, IL; Oral and Maxillofacial Surgery Resident, Department of Oral and Maxillofacial Surgery, Carle Foundation Hospital, Urbana, IL.
⁵ Oral and Maxillofacial Surgeon and Faculty, Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, IL; Oral and Maxillofacial Surgeon and Faculty, Department of Oral and Maxillofacial Surgery, Carle Foundation Hospital, Urbana, IL.

PMID: 38527728
DOI: 10.1016/j.joms.2024.03.002

Abstract

Background: Though the epidemiology of craniomaxillofacial (CMF) fractures has been well documented at urban hospitals, the characteristics of these fractures in rural hospitals have not been well studied.

Purpose: The purpose of this study is to report on the epidemiology of CMF fractures at a regional Level 1 trauma center serving a large rural population in central Illinois.

Study design, setting, sample: This is a retrospective cohort study at a community-based regional tertiary referral center that serves a predominantly rural population. Inclusion criteria comprised patients with radiologically confirmed CMF fractures between 2015 and 2019. Patients with incomplete medical records were excluded.

Predictor variable: Predictor variables included demographics (age, admission source, race, and sex) and etiology of CMF fracture (assault/domestic violence, all-terrain vehicle/off-road, falls, farm-related, motor vehicle collisions, gunshot wound, and others).

Main outcome variable: The primary outcome variable was the CMF anatomic location including nasal bone, orbit, mandible, malar/maxillary, and other CMF fractures.

Covariates: The covariates are not applicable.

Analyses: Descriptive statistics were used to summarize a sample of the population characteristics. Wilcoxon ranked sign tests and χ² tests of independence were used to assess for statistically significant associations between select variables of interest. Statistical significance was defined as P < .05.

Results: Between 2015 and 2019, a total of 2,334 patients presented to the emergency department with a CMF fracture. After applying the inclusion/exclusion criteria, the final sample was composed of 1,844 patients for the management of 2,405 CMF fractures. The majority of patients were male(62.0%) and young adults (aged 18-39) had the highest number of CMF fractures (819) relative to all other age groups. The most common fracture etiology was fall(37.3%), and nasal bone fractures represented the most common fracture location(41.6%). χ² analyses revealed statistically significant associations between the anatomic location of CMF fracture incurred, and differing categories of age, admission source, race, sex, and etiology.

Conclusion and relevance: Our study shows that patients seen at our Midwestern Level 1 trauma center are more likely to present with nasal bone and malar/maxillary fractures due to falls. In studies based in urban centers, patients are likely to present with orbital and mandibular fractures due to falls and assault.