Wasicek Philip J, Gebran Selim G, Elegbede Adekunle, Ngaage Ledibabari M, Rasko Yvonne, Ottochian Marcus, Liang Fan, Grant Michael P, Nam Arthur J
Division of Plastic and Reconstructive Surgery.
R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
J Craniofac Surg. 2020 Jun;31(4):956-959. doi: 10.1097/SCS.0000000000006294.
The purpose of this study was to characterize differences in facial fracture injury patterns among pediatric patients at highest risk of abusive head trauma/nonaccidental trauma (age ≤ 5 years).
Using the National Trauma Databank from 2007 to 2015, patients (age ≤ 5 years) suffering facial fractures were included. Demographics and injury characteristics were compared between those sustaining accidental versus nonaccidental trauma (NAT).
Over 9 years 9741 patients were included with 193 patients (2.0%) suffering NAT. Nonaccidental trauma patients were younger (median [interquartile range]; 0 [0, 2] versus 3 [1, 4], P < 0.001), and more frequently were insured by Medicaid (76.7% versus 41.9%, P < 0.001). NAT patients were more likely to sustain mandible fractures (38.9% versus 21.1%, P < 0.001), but less likely to sustain maxilla (9.8% versus 18.3%, P = 0.003), or orbital fractures (31.1% versus 53.4%, P < 0.001). Nonaccidental trauma patients had fewer instances of multiple facial fracture sites (8.9% versus 22.6%, P < 0.001). Among those sustaining mandible fractures, NAT patients were more likely to sustain condylar fractures (75.8% versus 48.4%, P < 0.001), but less likely to sustain subcondylar fractures (0% versus 13.2%, P = 0.002), or angle fractures (1.6 versus 8.7%, P = 0.048).
Differences exist in facial fracture patterns in accidental versus nonaccidental trauma within the pediatric population at highest risk for abusive head trauma. Specifically, NAT is associated with fractures of the mandibular condyle and involve fewer facial fracture sites. In the appropriate context, presence of these fractures/patterns should increase suspicion for NAT.
本研究的目的是描述受虐待性头部创伤/非意外创伤风险最高的儿科患者（年龄≤5岁）面部骨折损伤模式的差异。
使用2007年至2015年的国家创伤数据库，纳入面部骨折的患者（年龄≤5岁）。比较了遭受意外创伤与非意外创伤（NAT）患者的人口统计学和损伤特征。
在9年期间，共纳入9741例患者，其中193例（2.0%）遭受NAT。非意外创伤患者年龄更小（中位数[四分位间距]：0[0,2]岁对3[1,4]岁，P<0.001），且更常由医疗补助计划承保（76.7%对41.9%，P<0.001）。NAT患者更易发生下颌骨骨折（38.9%对21.1%，P<0.001），但发生上颌骨骨折（9.8%对18.3%，P=0.003）或眼眶骨折的可能性较小（31.1%对53.4%，P<0.001）。非意外创伤患者多处面部骨折部位的情况较少（8.9%对22.6%，P<0.001）。在发生下颌骨骨折的患者中，NAT患者更易发生髁突骨折（75.8%对48.4%，P<0.001），但发生髁突下骨折（0%对13.2%，P=0.002）或角部骨折的可能性较小（1.6%对8.7%，P=0.048）。
在受虐待性头部创伤风险最高的儿科人群中，意外创伤与非意外创伤的面部骨折模式存在差异。具体而言，NAT与下颌骨髁突骨折相关，且涉及的面部骨折部位较少。在适当的情况下，这些骨折/模式的存在应增加对NAT的怀疑。
