Defining predictable patterns of craniomaxillofacial injury in the elderly: analysis of 1,047 patients

Abstract

Purpose: Currently, nearly 1 in 5 Americans is at least 60 years of age. Bone atrophy, decreased capacity for tissue repair, and chronic disease are known to influence fracture patterns and operative algorithms in this age group. This study presents craniofacial trauma injury patterns and treatment in an elderly population at a major urban trauma center.

Methods: Patient records were retrospectively reviewed from February 1998 through December 2010. Patients at least 60 years of age who met the inclusion criteria for craniofacial fractures identified by International Classification of Diseases, Ninth Revision code review and confirmed by author review of available computed tomograms were studied. Demographic information, fracture type, concomitant injuries, and management were recorded.

Results: Of 11,084 patients presenting with facial fracture, 1,047 were older than 60 years. The most common mechanism of injury was falls (50%), and most patients were men (59%). Commonly fractured areas included the nose (n = 452, 43%), maxilla (316, 30%), zygoma (312, 30%), orbital floor (280, 27%), and mandible (186, 18%), with 51 patients (5%) having a concomitant basilar skull fracture. Inpatient mortality and length of stay were significantly increased compared with the nongeriatric population (P < .01), although only 5% of all fractures were treated operatively.

Conclusions: Fractures in the elderly tend to be minimally displaced midfacial fractures that do not warrant surgical intervention. Despite conservative management, the elderly are hospitalized longer than their younger counterparts, have increased critical care needs, and have higher mortality. These data support national medical preparedness in anticipating the craniofacial trauma needs of the aging US population and can be used to update treatment algorithms for these patients.