Violence Against Women: Facial Fractures Secondary to Assault in the Urban Female Population
Nicholas C. Oleck, BA, Farrah C. Liu, BS, Jordan N. Halsey, MD, Edward S. Lee, MD, Mark S. Granick, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.
PURPOSE: Assault has been frequently indicated as a major cause of facial trauma in the United States and around the world. Facial fractures secondary to assault have been shown to occur at a much higher rate in the male population as opposed to females. While these injuries may occur less frequently in females, they remain a significant medical problem within this demographic as facial trauma is one of the most frequently reported injuries resulting from domestic violence against women. Numerous studies have examined facial fractures in the general population, but few have assessed these injuries in females specifically. The objective of this study is to assess facial fractures secondary to assault in the female population. We intend to examine the prevalence and specific mechanism of action of these injuries in order to develop effective management strategies and decrease the likelihood of future injury.
METHODS: All facial fractures between the years 2001 and 2011 were retrospectively reviewed based on International Classification of Disease (ICD-9) codes. The facial fractures included in this study were the result of assault in the female population in an urban, level 1 trauma center (University Hospital, Newark, NJ). Results were categorized by patient demographics, location of fractures, concomitant injuries, length of hospital stay, critical complications, and surgical management strategies.
RESULTS: From 2001 to 2011, 139 female patients were identified as having sustained fracture(s) of the facial skeleton due to assault. Mean age was 34.61 (range 1-73) years. A total of 202 fractures were recorded and treated. Most common fracture sites were those of the mandible (35.15%), orbit (22.28%), zygoma (15.84%), nasal bone (14.35%), and zygomaticomaxillary complex (7.92%). A Glasgow Coma Scale score was documented for 33 patients, averaging 13.7 (range 7-15). 16 patients were intubated on, or prior to, arrival to the ED. 100 patients required a surgical airway. Intubation in the ED was significantly associated with increased length of stay (P<0.0001). The most common concomitant injuries were facial/scalp lacerations (22.3%), maxillary sinus fracture (8.63%) and skull fracture (8.63%). 106 patients required surgical intervention. Of these, 32 required open reduction and internal fixation, 12 required closed reduction, and 22 underwent both open and closed reductions. 37 patients required soft tissue management and laceration closure. Average hospital length of stay was 5.8 days (range 1-58). 9.23% of the patients were admitted to an intensive care setting, while 90.77% were admitted to this hospital. One patient expired.
CONCLUSION: Traumatic facial injuries secondary to assault remain a significant medical problem in the urban female population. The authors hope that this study can provide some insight and further investigation in to this topic as there is a dearth of literature regarding the management of facial fractures due to assault of the female population. Beyond the surgical treatment of facial fractures, it is necessary to examine the patterns of injury and presentation in order to improve prevention techniques, screening tools, and psychological support for victims of assault.
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