SA1 - Are Sports-Related Maxillofacial Injuries Associated With Distinct Fracture Patterns?

Abstract:

Background: Mechanisms of facial trauma and resultant facial fracture patterns have evolved over time, due to public health policy implementation and technological advancements1. There are numerous published reviews investigating the facial fracture patterns associated with specific traumatic mechanisms, however, few studies investigated fracture patterns associated with sports-related injuries in the United States2.

Aim: We aim to expand upon the current understanding of traumatic mechanisms and associated facial fracture patterns, through a retrospective study of maxillofacial fractures sustained during participation in athletic activities. We hypothesized that: 1.) contact-sports would have a higher incidence of facial fractures and 2.) the traumatic mechanism of collisions would be associated with more complex fracture patterns.

Methods: Retrospective analysis of cases of traumatic maxillofacial fractures sustained during sporting events, that were evaluated by Oral and Maxillofacial surgeons at a single institution between 2015 and 2023. Individual patient records were reviewed for: specific sport, reported traumatic mechanism, and number and location of maxillofacial fractures sustained. We subclassified traumatic mechanisms as the following: projectiles (direct blow from airborne sports equipment), strikes (direct blow from opponent), falls, and collisions. The collision mechanism was further divided into person-to-person collisions (patient colliding with another player) and person-object collisions (patient colliding with immobile object, such as a pole).

Results: Review of 1,392 maxillofacial trauma patients identified 56 patients diagnosed with facial fractures sustained during participation in a sport. The mean age was 27. There was a male predominance of sports-related maxillofacial injuries at 79% (n= 44). Sports-related facial fractures were sustained during eighteen different types of sports, with maxillofacial injuries being sustained most frequently during hockey, softball, and non-tackle American football (Table 1). Contact sports did not have a significantly higher incidence of facial fractures.Sports participation resulted in a total of 127 facial fractures (Table 2). All maxillofacial regions were affected, and unilateral mandibular fractures were the most common presentation, followed by complex unilateral OZMC fractures. The frontal bone was the least frequently fractured. On average, sports-related maxillofacial injuries resulted in a mean of 2.35 fractures per patient. A direct blow from a projectile piece of sports equipment was the mechanism reported most frequently 29% (n=16) (Table 3). Person-to-person collisions, strikes, and person-object collisions were the reported mechanism in 27%, 20%, and 16% of sports-related facial fracture patients, respectively. The mechanism of a fall to the ground during participation in sports, was reported the least (9%, n=5). Most sports-related facial fractures were sustained without evidence of injury outside of the maxillofacial complex (n=53) and only 14% (n=8) patients sustained a concomitant dentoalveolar injury.

Discussion: Sports-related maxillofacial injuries represented 4% of patients with facial fractures between 2015 and 2023. This incidence is lower than previously reported and is likely due to that the present study only included facial fracture patients and excluded those with isolated soft tissue injuries.18% of the reported facial fractures occurred during participation in hockey. The most common fracture reported was of the mandible, which occurred most frequently due to a direct blow from projectile sports equipment. These findings contrast those reported in previous literature. We did not observe distinct fracture patterns associated with participation in specific sports.Fewer than half of the patients in this cohort sustained facial fractures during contact sports, compared to limited-contact or non-contact sports. Thus, we fail to reject our null hypotheses. Severity and incidence of facial fractures was not significantly more associated with contact sports nor the mechanism of person-to-person collision. Additional research is necessary to assess current use of protective gear to inform changes in athletic rules and innovation in safety equipment.

References: 1. DOI: 10.1016/j.joms.2011.02.0572. DOI: 10.1016/j.csm.2016.11.007

Table 1: Distribution of patients by sport
Table 2: Individual facial fracture distribution
Table 3: Characterization of sports-related mechanism of trauma