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Le Fort Fractures in the Pediatric Population: A Level I Trauma Center Review

Moffitt, Joseph BS; Wainwright, D’Arcy J. BS; Teichgraeber, John F. MD; Greives, Matthew R. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 54-55
doi: 10.1097/01.GOX.0000584516.49551.9e
Craniofacial Abstracts
Open

McGovern School of Medicine at The University of Texas Health Science Center, Houston, TX

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Pediatric Le Fort fractures are a small subset of facial fractures requiring more intervention to manage the patient and stabilize the floating midface. Our purpose was to identify associated factors for patients with Le Fort fractures.

METHODS: An Institutional Review Board–approved retrospective chart analysis of all pediatric patients ≤18 years old diagnosed with facial fractures at our level I trauma center over a 10-year period (January 2006 to December 2015) was performed. Demographics, fracture location, mechanism of injury, and hospital course were abstracted. Statistical analysis was then performed comparing facial fracture patients with Le Fort fractures and facial fracture patients without Le Fort fractures.

RESULTS: A total of 1,274 patients met inclusion criteria. Of these, 69 (5.4%) presented with Le Fort fractures. Factors associated with Le Fort fractures included motor vehicle accidents (P < 0.001), increased age (P < 0.001), and traumatic brain injury (P < 0.04). Patients with Le Fort fractures were more likely to need intensive care unit admission (P < 0.001), surgical management (P < 0.001), transfusions (P < 0.001), secondary fixation surgery (P < 0.001), and have a longer length of stay (P < 0.001). Multivariate showed increased odds for increased age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.04–1.17) and concomitant orbit fractures (OR, 8.33; 95% CI, 4.08–19.34). Decreased odds were associated for all mechanisms of injury other than motor vehicle collision (other blunt trauma: OR, 0.36; 95% CI, 0.2–0.6; penetrating trauma: OR, 0.13; 95% CI, 0.01–0.6).

CONCLUSION: Le Fort fractures represent a small portion of pediatric facial fractures but require critical management. Careful evaluation of patients following motor vehicle accidents for midface stability will allow for proper planning and patient management.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.