1. Outcomes of Craniofacial Fractures in All – Terrain Vehicle Accidents.

2. Fernando Herrera MD1,2, Al Hassanein, MD1, Ahmed Suliman MD1,2, Raul Coimbra, MD, PhD1
University of California San Diego, Division of Trauma, Critical Care, and Burn Surgery1, University of California Los Angeles, Division of Plastic and Reconstructive Surgery2
Nothing to disclose

3. Introduction
All-Terrain Vehicle (ATV) use is a common recreational hobby in Southern California.
Purpose of this study is to determine frequency and distribution of craniofacial fractures sustained from off-road ATV accidents.

4. Materials & Methods
Retrospective review: ATV injuries from 1985 to 2007.
Patients with craniofacial fractures were identified.
Fractures organized into 4 anatomic subunits (frontal/skullbase, upper midface, lower midface, and mandible).

5. Materials & Methods
Patient demographics, Facial abbreviated injury score (AIS), Glasgow coma score (GCS).
Length of hospital stay (LOS), associated injuries.
Use of safety equipment, and alcohol were recorded and analyzed.

6. Anatomical Subunits 1 2 3 4
Frontal sinus, orbital roof/surpa-orbital rim, skull base
Orbital:Lat/medial, floor, Nasal, NOE, Zygomatic arch, ZMC, Leforte II/III
Maxillary sinus, hard palate, Leforte I, ZMC, Leforte II/III
Mandible
ZMC and Le Fort II/III fractures were counted as fractures of both the upper and lower midface subunits.

7. Results 433 ATV related injuries from 1985-2007.
Forty-seven patients (11%) sustained a total of 93 craniofacial fractures.
Mean age was 28.5 years (range ). 82% male, 13% female.
Average facial AIS score was 2.2 (moderate), average GCS was 12.5.

8. Results
Involved Facial Subunit: frontal/skull base: 19 pts, upper midface: 34 pts, lower midface:27 pts, mandible:12 pts.
Most common fracture type: Orbital followed by nasal.
Isolated craniofacial fractures 36%.

9. Individual Fractures Fracture Type Total Number (N) Orbital 22 Nasal20
Maxilla 18
Zygoma/ZMC 10
Mandible 12
LeForte I 2
LeForte II
LeForte III 3
Frontal Sinus
Nasoorbitoethmoidal 1

10. Results Length of hospital (LOS) stay: 8.4 days, average 3.7 ICU days.
Closed head injuries occurred in 32%.
Safety gear use documented in 32%, alcohol use documented in 15%.
38% required operative fixation on index hospitalization.

11. Associated Injuries

12. Conclusion ATV injuries are a significant public health concern.
Craniofacial fractures occurred in 11% of patients due to ATV related accidents.
The upper mid-face subunit was the most commonly affected facial region.
Neurological injuries were the most common associated injuries.