Outcomes of Craniofacial Fractures in All – Terrain Vehicle Accidents

Purpose: All-terrain vehicles (ATV) were introduced into the US market in the late 1970s and have become a popular form of motorized recreation since their introduction. The growing popularity and use of All-terrain vehicles has resulted in an increased incidence of ATV-related injuries. The purpose of this study was to determine frequency and distribution of craniofacial fractures sustained from ATV accidents and associated injuries.

Methods: The medical records of all patients presenting to a single trauma center with ATV injuries from 1985 to 2005 were reviewed. All patients with craniofacial fractures were included in our study. The fractures were organized into anatomic subunits (frontal/skullbase, upper midface, lower midface, and mandible). The individual fractured bones were then identified and patient demographics, length of hospital stay (LOS) , associated injuries, injury severity score (ISS), facial abbreviated injury score (AIS), use of safety equipment, and presence of alcohol were recorded and analyzed.

Results: A total of 433 ATV related injuries presented to a level 1 trauma center from 1985-2005. Forty-seven patients (11%) sustained maxillofacial fractures. Mean age was 28.5 years (range 14 to 71). There were forty-one males (82%) and six females (13%). The frontal/skull base subunit was involved in 19 patients, upper midface in 34 patients, lower midface in 27 patients, and mandible in 12 patients. The orbit was the most commonly fractured bone followed by nasal bone. Average facial AIS score was 2.23, ISS was 18.7, and GCS was 12.5. Length of hospital stay was 8.4 days, with an average 3.7 ICU days. Seventeen patients (36%) suffered isolated craniofacial fractures, the remainder suffered a variety of associated injuries. The most common associated injury was neurological with 15 patients (32%) suffering closed head injuries. Safety gear was documented in only 15 patients (32%) and alcohol use was documented in 7 patients (15%). Of the 47 patients suffering maxillofacial fractures only 18 patients (38%) went onto require operative fixation on the initial hospitalization. Patients not wearing safety equipment had a significantly higher ISS score (p=0.025).

Conclusion: The incidence, severity, and economic burden for ATV related injuries continue to rise. Craniofacial fractures, specifically involving the upper midface subunit are a common injury among ATV related accidents with neurological trauma being the most commonly associated finding.