Patterns of pediatric mandible fractures in the United States

Abstract

IMPORTANCE The mandible is arguably the most frequently fractured facial bone in children. However, facial fractures are rare in children compared with adults, resulting in few large studies on patterns of pediatric facial fractures. OBJECTIVE To report the patterns, demographics, and cause of pediatric mandible fractures across the United States. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysiswas conducted of the Healthcare Cost and Utilization Project's National Emergency Department Sample from January 1 to December 31, 2012, using the International Classification of Disease, Ninth Revision, codes for mandible fractures (802.20-802.39) among patients 18 years and younger who presented to emergency departments. Demographics, fracture site, and fracture mechanism were analyzed to identify factors associated with fractures. Analysis was conducted from July 9 to July 28, 2015. RESULTS There were 1984 records, representing a weighted estimate of 8848 cases of pediatric mandible fracture. The mean patient age was 14.0 years (95%CI, 13.6-14.3). The male to female ratio was 4:1 and females were comparatively younger, with a mean age of 12.5 years (95%CI, 11.8-13.1; P < .001). The most frequently fractured sites were the condyle, in 1288 patients (14.6%[95%CI, 12.6%-16.5%]), and the angle, in 1252 patients (14.1% [12.4%-15.9%]). Associated intracranial injuries occurred in 756 patients (8.5%[7.1%-10.0%]), and cervical spine fractures occurred in 393 (4.4%[3.5%-5.4%]). The fracture site and mechanism of injury varied with age and sex. For patients 12 years and younger, the most frequent fracture site was the condyle, accounting for 636 fractures (27.9%[24.2%-31.6%]), and the most frequent cause was falls, accounting for 692 fractures (30.3%[25.9%-34.8%]). In teenaged patients (13-18 years), the angle was the most frequent fracture site, accounting for 1157 fractures (17.6%[15.6%-19.6%]), and the most frequent cause was assault, accounting for 2619 fractures (39.9%[36.4%-43.3%]). For male patients, the angle was the predominant site, accounting for 1053 fractures (15.0%[13.1%-16.8%]), and the leading cause was assault, accounting for 2360 fractures (33.5%[30.2%-36.9%]). For female patients, the condyle was the most frequent site, accounting for 369 fractures (20.3%[16.0%-24.6%]), and the leading cause was falls, accounting for 422 fractures (23.2%[18.6%-28.0%]). CONCLUSIONS AND RELEVANCE In this study, age and sex disparities among pediatric mandible fractures were identified. Younger patients and female patients tend to have condyle fractures caused more commonly by falls while older patients and male patients tend to have angle fractures caused by assault.