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Pedestrian injury due to motor vehicle crashes can be especially destructive to the pediatric population as the facial skeleton has immature growth centers, leading to possible long-term defects in form and function. To our knowledge, there are few studies examining fractures patterns of this etiology, and thus a lack of literature for management strategies to optimize functional recovery in this specific population.
METHODS:
A retrospective chart review was performed for all facial fractures resulting from motor vehicle collisions with pedestrians in the pediatric population at a level 1 trauma center in an urban environment (University Hospital in Newark, NJ) from 2002 to 2012. Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies.
RESULTS:
During the time period examined, 55 patients were identified as 18 years of age or younger and having sustained a facial fracture as the result of being struck by a motor vehicle. The mean age was 11.3 (range 1 – 18) years, with a male predominance of 69.0%. There were a total of 107 fractures identified on radiologic imaging via CT or X-ray. The most common fractures were those of the orbit (23.4%), mandible (22.4%), and nasal bone (17.8%). Distribution of fractures by anatomical sites is demonstrated in Figure 1. The mean Glasgow Coma Scale on arrival was 12.1 (range 3 – 15). Twenty-one patients were intubated on, or prior to, arrival to the trauma bay. The most common concomitant injuries were skull fractures (25.3%), intracranial hemorrhage (22.2%), long bone fractures (15.2%), and intrathoracic injuries (15.2%). Distribution of concomitant injuries is shown in Figure 2. Of the 55 patients, 72.7% suffered from traumatic brain injury. The mean operative time was 216.9 (range 63 – 515) minutes. Surgery was required in 20 patients, with most undergoing open reduction and internal fixation with titanium plates and screws. Two patients required resorbable plates, and one required Medpor implants. The mean hospital length of stay was 9.3 (range 1 – 59) days. Three patients expired.
CONCLUSIONS/SIGNIFICANCE:
There is currently a dearth of literature regarding the management and patterns of injury for pediatric pedestrian injuries due to motor vehicle collisions. The impact of these injuries can be devastating with concomitant life-threatening complications, and may influence the future development of the facial skeleton after healing of the bone and soft tissue. The authors hope this study can provide insight and further investigation regarding prevention and management.