Analyzing Epidemiology and Hospital Course Outcomes of LeFort Fractures in the Largest National Pediatric Trauma Database

Abstract

Study Design Retrospective observational study. Objective This study analyzes the epidemiology of pediatric Le Fort fractures and assesses the incidence of concomitant injuries and acute-level hospital course using the largest, national pediatric trauma database to date. Methods Pediatric midface and Le Fort fractures from 2016-2019 were identified in the National Trauma Data Bank. Descriptive analyses of Le Fort compared to non-Le Fort midface fractures were performed. Multivariable regression assessed whether Le Fort fractures were risk factors for ICU admission, intracranial injury, cervical spine (C-spine) fracture, tracheostomy, and mortality. Results A total of 1489 patients with Le Fort fractures were identified. There were 520 Le Fort I, 632 Le Fort II, and 609 Le Fort III fractures. Fracture incidence increased with age. Le Fort fractures showed higher rates of concomitant intracranial injury ( P < 0.001), ICU admission ( P < 0.001), C-spine fracture ( P < 0.001), and tracheostomy ( P < 0.001). Incidence of all the above increased with higher-grade Le Fort fractures. Le Fort III fractures had higher rates of mortality than non-Le Fort midface fractures (7.6% vs 3.2%). Multivariable regression showed that all Le Fort patterns were independent risk factors for tracheostomy and ICU admission, but only Le Fort I for C-spine fractures. Conclusions The incidence of Le Fort fractures appears to increase with age. Higher category Le Fort fractures are associated with greater morbidity.