Concomitant Facial Fractures: A National Evaluation of Patients, Prevalence, and Fracture Patterns.

Background: Facial fractures may present with one or more additional facial fractures and result in significant morbidity. The authors evaluated the prevalence of concomitant facial fractures within the United States.

Methods: The authors retrospectively reviewed patients in PearlDiver, a national deidentified claims database from 2010 through 2020, who had concomitant facial fracture surgery identified by Current Procedural Terminology (CPT) codes reported within 30 days of presentation. Fracture treatment interventions were further categorized by open reduction, open reduction internal fixation (ORIF), and closed reduction.

Results: A total of 244,751 patients were identified in the database and included in the study. The average age was 39 years old, 45% were female, and 76% were commercially insured. The most common surgically treated fracture was nasal bone fracture with closed reduction (57%). A total of 32% of naso-ethmoidal (NOE) ORIFs had a concomitant malar fracture, whereas 2.5% of malar ORIFs were found to have a concurrent NOE. For Le Fort-type fractures, 28% of Le Fort I and 32% of Le Fort II ORIFs had a concomitant malar fracture. Similarly, 28%, 22%, and 30% of Le Fort I, II, and III ORIFs, respectively, had a concomitant orbital floor blow-out fracture. An estimated 20% of malar ORIFs had an orbital bone fracture, and 16% of all orbital bone ORIFs had a concomitant malar fracture.

Conclusion: Le Fort-type, malar, and orbital fractures that require ORIF will likely have a second concomitant facial fracture. Surgeons should exercise a high index of suspicion for co-occurring fractures in these patients.