Interpersonal Violence-Related Facial Fractures: 12-Year Trends and Surgical Outcomes in a Southern European Level-I Trauma Centre

Abstract

Background and Objectives: Interpersonal violence (IPV) has overtaken road traffic collisions as a leading cause of facial fractures, yet regional data from Southern Europe are limited. Materials and Methods: We retrospectively reviewed all adults (≥18 y) treated between 1 January 2011 and 31 December 2022 for radiologically confirmed IPV-related facial fractures. Recorded variables were demographics, AO-CMF (Arbeitsgemeinschaft für Osteosynthesefragen-Craniomaxillofacial) fracture site, Facial Injury Severity Score (FISS), presence of facial soft-tissue wounds, treatment modality, and length of stay; associations between variables were explored. Results: A total of 224 victims were identified; 94% were men (median age 26 y, IQR 22-34). The mandible was the most frequently involved bone (42%), followed by the orbit (25%); 14% sustained fractures at multiple sites. Facial soft-tissue wounds occurred in 9% of cases, three-quarters of which were associated with mandibular injury (p = 0.005). The median FISS was 2 and was higher in males, patients > 34 y, those with multiple fractures, and those with wounds (all p < 0.05). FISS showed a weak positive correlation with hospital stay (r = 0.23), which averaged 4.1 ± 1.6 days. Open reduction and internal fixation were required in 78% of patients, most often 24-72 h after admission. Annual IPV-related admissions remained stable throughout the 12-year period. Conclusions: IPV in this region consistently injures young men, with the mandible and orbit most at risk. FISS is a practical bedside indicator of resource use. The unchanging incidence-likely underestimated because isolated nasal fractures and minor injuries are often managed outside maxillofacial services or never reported-highlights the urgency of targeted prevention programs, routine screening, and streamlined multidisciplinary pathways.

Keywords: epidemiology; facial fractures; facial injury severity score (FISS); interpersonal violence; maxillofacial trauma.

Figure 1

Distribution of fracture associations in patients with injuries from interpersonal violence. The bar chart shows the percentage of patients presenting with various combinations of fracture sites. The most frequent associations involved the frontal sinus, orbital floor, nose, and zygomaticomaxillary complex (COMZ), with 23%, and the orbital floor and nose, with 23%.

Figure 2

Sex-based distribution of fracture locations in patients with injuries from interpersonal violence. Stacked bar plots represent the percentage of male (M, n = 211) and female (F, n = 13) patients, according to fracture location. The bars are segmented into four categories: orbital floor, mandible, zygomaticomaxillary complex (COMZ), and multiple associated fractures. ** = p < 0.01.

Figure 3

Age distribution of patients with fractures. The box plots represent the median and interquartile range of ages. * = p < 0.05, ** = p < 0.01.

Figure 4

FISS scores according to anatomical site of fracture. Box plots show Facial Injury Severity Scale (FISS) scores across different fracture patterns: mandibular, zygomaticomaxillary complex (COMZ), orbital floor, and multiple fractures. The plot displays the median and interquartile range for each group. Patients with multiple fractures exhibited the highest FISS scores. A statistically significant difference was observed among the groups. *** = p < 0.001.

Figure 5

Severity of facial trauma is associated with longer hospitalization. The scatter plot illustrates the correlation between the number of hospitalization days and FISS.

Figure 6

Facial Injury Severity Scale (FISS) scores in relation to treatment approach. Box plots display the distribution of FISS scores across different treatment groups. Each box represents the interquartile range (IQR), with the horizontal line indicating the median value. Statistically significant differences were observed between treatment groups. *** = p < 0.001.