(96) Shifting Patterns in Facial Trauma Among the Elderly: Orbital Floor Fractures as the Most Common Injury

Abstract:
Statement of the Problem: Maxillofacial literature has traditionally cited nasal bone fractures as the most common facial fractures in emergency rooms due to the nasal pyramid’s anatomical prominence. However, this may reflect biases in epidemiological data, injury mechanisms, and demographics. Since 2010, Puerto Rico’s elderly population has doubled, leading to increased strain on healthcare, particularly in emergency departments (EDs). Falls, a common ED visit cause in older adults, pose significant risks due to age-related issues like balance loss, muscle weakness, and osteoporosis. At our hospital, which handles all maxillofacial trauma in Puerto Rico, isolated orbital floor fractures were identified as the most common facial fracture over a three-year period. This study aims to report the incidence, prevalence, and local epidemiology of orbital floor fractures in elderly patients in Puerto Rico.
Materials and

Methods: This retrospective cohort study analyzed Electronic Health Records (EHR) from 2020-2022 at the “Administración de Servicios Médicos (ASEM)” Hospital, the island’s only Level I Trauma Center. Inclusion Criteria: patients (≥65 years) with isolated orbital floor fractures diagnosed by oral and maxillofacial surgeons. Exclusion Criteria: multiple facial fractures or incomplete medical records. Chi-Square Test (P < .05) was used to analyze prevalence and incidence trends. Descriptive statistics were also applied.

Results: Of 1,958 consultations, 528 involved multiple fractures, and 218 met our criteria. The prevalence per 1,000,000 population was 2.04%, 2.2%, and 2.5% for 2020-2022, respectively. Incidence for 2021-2022 was 0.3 and 0.9, respectively. Chi-Square analysis showed a P value of .45 for prevalence and .020 for incidence. The mean age was 78.8 years (SD 8). Women represented 68.8% (150 cases), while men accounted for 31.2% (68 cases). The right orbital floor was more frequently affected (53%) than the left (46.8%). Falls were the most common cause (87.6%), while motor vehicle accidents (MVAs) and aggressions were more common in men (5.9%).

Conclusion: While literature typically reports nasal bone fractures as the most common facial trauma in emergency settings, our study found that isolated orbital floor fractures were more prevalent among elderly patients in Puerto Rico. Over the three years (2020-2022), the incidence of these fractures significantly increased (P = .020), though prevalence remained unchanged (P = 0.45). Falls were the leading cause of injury (87.6%), consistent with the growing elderly population and age-related vulnerabilities. Women were more affected (68.8%), and the right orbital floor was slightly more commonly injured. These findings stress the importance of localized data to inform preventive strategies, resource allocation, and clinical focus for aging populations, whose injury patterns may differ from broader datasets.
References
1. Iftikhar, M., Canner, J. K., Hall, L., Ahmad, M., Srikumaran, D., & Woreta, F. A. (2021). Characteristics of orbital floor fractures in the United States from 2006 to 2017. Ophthalmology, 128(3), 463-470.
2. Alvi, A., Doherty, T., & Lewen, G. (2003). Facial fractures and concomitant injuries in trauma patients. The laryngoscope, 113(1), 102-106.
-Prevalence and incidenceDescriptive analysis for orbital floor fracturesMechanism of injury by gender