Abstract
Craniofacial trauma involving the anterior skull base produces a heterogenous injury
with variance in fracture pattern, complexity and outcome. Variance is influenced
by the biomechanical properties of the craniofacial construct and by the magnitude
and vector of the impacting energy. Fractal dimension and other metrics applied to
individual fracture patterns allows quantification of fracture complexity and severity,
which can be used to correlate with neurological outcome. Frontobasal fractures from
81 patients admitted to two UK major trauma centres were analysed. Patients were divided
into two groups: those with anteriorly-based vectors of impact and those with laterally-based
vectors. Osseous disruption was quantified by: fractal dimension, fracture length,
number of termini, and number of nodes, and then compared with neurological outcome
using first recorded Glasgow Coma Score (GCS), and requirement for intubation. As
fracture length increased, fractures from anterior impacts became more complex and
reticulated compared with lateral impacts; fractal dimension also increased more rapidly
for anterior impacts. Longer fracture length in both groups was associated with a
significantly lower GCS, and increased requirement for intubation (p < 0.001 and p < 0.001
respectively). Fracture propagation and severity of head injury was different in anterior-directed
trauma compared to lateral-directed trauma. Consequently, we suggest that the central
region of the anterior skull base acts to primarily absorb impact force thereby behaving
as a protective ‘ crumple zone ’ . In severe mechanisms the protective mechanism is
exceeded and the fracture length tended to that of the lateral group worsening prognosis.
Keywords
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Article Info
Publication History
Published online: November 16, 2021
Accepted:
November 9,
2021
Identification
Copyright
© 2021 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
