Patterns of Maxillofacial Injures Caused by Motorcycle Accidents

Abstract Introduction Motorcycles are used as a common means of transportation, and motorcycle accidents are responsible for a major portion of trauma injuries. Objectives The purpose of this study was to analyze the patterns of facial injuries in motorcyclists, to evaluate the types of injuries, and to investigate if the accidentrelated factors had any impact on the characteristics of the injuries. Methods This retrospective observational study included 74 patients with maxillofacial injuries following motorcycle-related accidents. Investigated data were divided into four main categories: sociodemographic, accident-related, injury-related, and treatment-related. Results All the patients were males with a mean age (±SD) of 25.03 (±9.986) years. Most accidents (n = 44, 59.4%) occurred in the evening. Most of the patients (n = 40, 54%) were traveling on motorcycle models that had maximum speed of over 120 km/h. Furthermore, 15 patients (18.9%) were under the influence of alcohol during the crashes and only one patient was wearing a helmet. Fractures of the maxillofacial bones were observed in 50 (67.5%) crash victims; 24 of them (48%) had middle third fractures, 11 (22%) had mandibular fractures, and 15 patients (30%) presented with a combination of lower, middle, and upper third fractures. Conclusion Almost all patients were not wearing helmets at the moment of the crash. The most common fractured site was the maxilla. The majority of the patients received surgical treatment. Increased enforcement of safety measures for riders and raising awareness about the dangers of motorcycle crashes are required measures to improve traffic safety and, ultimately, population health.

Relationship between the use and types of helmets with facial injuries - a prospective study / Relação entre o uso e os tipos de capacetes e os traumatismo faciais - um estudo prospectivo

ABSTRACT Introduction: many studies have demonstrated the benefits of helmet to prevent and reduce severity of injuries in motorcyclists. Objective: the aim of the present study was to evaluate a possible relationship between the use of different types of helmets and the occurrence of facial injuries among victims of motorcycle accidents, seen at Hospital da Restauração, Recife/PE, Brazil. Materials and methods: demographic and trauma data were collected from hospitalized motorcycle accident victims with facial injuries from December 2020 to July 2021. Pearsons chi-square test was used to assess association between two categorical variables using a margin of error of 5%. Results: among the participants, the average age was 33.46 years. The age group between 18 and 29 years was the most prevalent. Most participants were male. 60.0% of motorcyclists used helmets at the time of the accident and of this percentage 37.6% used fixed full-face helmet, 16.5% open-face helmet and the other 5.9% articulated full-face helmet. 62.7% of participants had facial fractures. Among the fractures, those of the zygomatic-orbital complex were the most common fracture and were significantly associated with the use of helmets, especially with open-face helmet. Conclusions: the use of helmets was associated with a lower number of facial fractures among patients who were victims of motorcycle accidents. Fracture of the zygomatic-orbital complex was related to the absence of a helmet at the time of the accident, as well as the use of open-face helmets.

RESUMO Introdução: muitos estudos têm demonstrado os benefícios do uso de capacete para prevenir e reduzir a gravidade das lesões em motociclistas. Objetivo: o objetivo do presente trabalho consistiu em avaliar uma possível relação entre o uso dos diversos tipos de capacete e a ocorrência do trauma facial entre vítimas de acidentes motociclísticos atendidos no Hospital da Restauração, Recife/PE, Brasil. Materiais e Métodos: os dados demográficos e referentes ao trauma foram coletados de vítimas de acidentes motociclísticos hospitalizados com lesões faciais durante o período de Dezembro de 2020 a Julho de 2021. O teste do qui-quadrado de Pearson foi utilizado para avaliar a relação entre duas variáveis categóricas utilizando uma margem de erro de 5%. Resultados: a idade média dos participantes foi 33,46 anos. A faixa etária entre 18 a 29 anos foi a mais prevalente. A maioria dos participantes eram do gênero masculino. 60,0% dos motociclistas utilizavam capacetes no momento do acidente e deste percentual 37,6% utilizavam capacete fechado, 16,5% capacete aberto e os outros 5,9% capacete escamoteável. 62,7% dos participantes tiveram fraturas faciais. Dentre as fraturas, as do complexo zigomático-orbitário foram as mais prevalentes e foram associadas com o uso de capacetes, especialmente os abertos. Conclusões: o uso de capacetes foi associado com um menor número de fraturas faciais entre os paciente vítimas de acidentes motociclísticos. A fratura do complexo zigomático-orbitário foi relacionada com a ausência de capacete no momento do acidente, bem como com o uso de capacetes abertos.

Epidemiologic characteristics of bicycle injury and helmet use

OBJECTIVE: This study examined the epidemiological characteristics of bicycle injuries and the wearing of a helmet. METHODS: A cross-sectional observational study was conducted using the emergency department-based Injury In-depth Surveillance data from 2013 to 2016. The study population consisted of patients related to bicycles of all ages. The variables associated with helmet wearing were sex, age, type of location, activity at injury, alcohol use at injury, and time of injury. Multivariable logistic regression analysis was conducted to estimate the risks of nonuse of helmets. RESULTS: Among the 31,923 eligible patients, 3,304 patients (10.3%) were wearing helmets at the time of the injury. The adjusted logistic regression model showed that females (adjusted odds ratio [aOR], 0.675; 95% confidence interval [CI], 0.614–0.742), teenagers (aOR, 0.265; 95% CI, 0.232–0.302), old age (aOR, 0.378; 95% CI, 0.326–0.438), road except for bicycle lanes (aOR, 0.510; 95% CI, 0.467-0.557), leisure (aOR, 0.290; 95% CI, 0.252–0.334) or vital activity (aOR, 0.188; 95% CI, 0.162–0.218) at injury, alcohol use at injury (aOR, 0.329; 95% CI, 0.253–0.427), night time (aOR, 0.609; 95% CI, 0.560–0.663), and winter (aOR 0.734; 95% CI 0.619–0.872) were significantly associated with the nonuse of helmets. CONCLUSION: This study identified the factors associated with helmet use during bicycle riding. Strategies aimed at increasing the use of bicycle helmets targeting the risk population are needed.

Relationship between Locations of Facial Injury and the Use of Bicycle Helmets: A Systematic Review

The aim of this study is to review the protective effect of a bicycle helmet on each facial location systematically. PubMed was searched for articles published before December 12, 2014. The data were summarized, and the odds ratio (OR) between the locations of facial injury was calculated. A statistical analysis was performed with Review Manager (The Nordic Cochrane Centre). Bicycle helmets protect the upper and middle face from serious facial injury but do not protect the lower face. Non-wearers had significantly increased risks of upper facial injury (OR, 2.07; P<0.001) and of middle facial injury (OR, 1.97; P<0.001) as compared to helmet users. In the case of lower facial injury, however, only a slightly increased risk (OR, 1.42; 95% confidence interval (CI), 0.67-3.00, P=0.36) was observed. The abovementioned results can be attributed to the fact that a helmet covers the head and forehead but cannot cover the lower face. However, helmets having a chin cap might decrease the risk of lower facial injury.

Road safety legislation in the Americas / Legislación sobre seguridad vial en las Américas

Legislating five of the main risk factors for road traffic injuries (RTIs), as much as enforcing the law, is essential in forging an integral culture of road safety. Analysis of the level of progression in law enforcement allows for an evaluation of the state of world regions. A secondary analysis of the 2009 Global status report on road safety: time for action survey was undertaken to evaluate legislation on five risk factors (speed management, drinking and driving, motorcycle helmet use, seatbelt use, and use of child restraints) in the Americas. Laws were classified depending on their level of progression: the existence of legislation, whether the legislation is adequate, a level of law enforcement > 6 (on a scale of 0-10), and whether the law is considered comprehensive. A descriptive analysis was performed. The totality of the countries has national or subnational legislation for at least one of the five risk factors. However, 63% have laws on the five risk factors studied, and none of them has comprehensive laws for all five. Seatbelt use appears to be the most extended enforced legislation, while speeding laws appear to be the least enforced. There are positive efforts that should be recognized in the region. However, the region stands in different stages of progression. Law enforcement remains the main issue to be tackled. Laws should be based on evidence about what is already known to be effective.

La legislación sobre cinco de los principales factores de riesgo de sufrir lesiones causadas por el tránsito, así como el cumplimiento de la ley, son esenciales para forjar una cultura integral de seguridad vial. El análisis del nivel de progresión en el cumplimiento de la ley permite evaluar el estado de las regiones del mundo. Se llevó a cabo un análisis secundario de la encuesta Informe sobre la situación mundial de la seguridad vial: es hora de pasar a la acción, de 2009, para evaluar la legislación sobre cinco factores de riesgo (control de la velocidad, conducir bajo la influencia del alcohol, uso del casco al conducir motocicletas, uso de cinturones de seguridad y uso de sistemas de retención para niños) en las Américas. Las leyes se clasificaron según su nivel de progresión: la existencia de legislación, si la legislación es adecuada, un nivel de cumplimiento de la ley > 6 (en una escala de 0-10) y si la ley se considera integral. Se realizó un análisis descriptivo. Todos los países tienen legislación nacional o subnacional al menos con respecto a uno de los cinco factores de riesgo; sin embargo, 63% tienen leyes sobre los cinco factores de riesgo estudiados, y ninguno de ellos tiene leyes integrales para los cinco. La legislación sobre uso de cinturones de seguridad parece ser la de mayor cumplimiento, mientras que las leyes de exceso de velocidad parecen ser las que menos se cumplen. En la región hay esfuerzos positivos que deben reconocerse; sin embargo, existen diferentes etapas de progresión. El cumplimiento de la ley sigue siendo el principal tema por abordar. Las leyes deben basarse en datos de eficacia reconocida.

The Influence of Wearing a Helmet on Facial Fractures Patterns in Injured Motorcycle Riders

PURPOSE: This study was undertaken in order to identify the influence of wearing a head protective device (helmet) on facial fracture patterns in injured motorcycle riders. METHODS: We retrospectively reviewed the medical records of patients who underwent facial bone computed tomography (CT) resulting from motorcycle riding injuries between May 2009 and July 2011. Data collected included age, gender, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), status of helmet use, alcohol intake, time of accident, seating position of the rider, traumatic head injury (THI) measure and facial fracture patterns. Facial fracture patterns were grouped as fracture of the upper-face (orbits), mid-face (maxilla, zygoma, nose) and lower-face (mandible). We assessed the association between facial fracture patterns and helmet use. RESULTS: Of the 180 patients included in this study, 163 (90.6%) were male, 60 (33.3%) suffered facial fracture, 85 (47.2%) wore a helmet and 30 (16.7%) suffered THI. Their mean age was 28.7+/-14.6 years. Between the helmeted and unhelmeted groups, there was statistically significant difference in age, GCS, RTS and THI. There was no significant association between wearing a helmet and type of facial fracture. Multivariate logistic regression analysis demonstrated that age was the only factor influencing helmet use. CONCLUSION: Wearing a helmet prevented traumatic head injury but did not prevent any particular type of facial fractures in the injured motorcycle riders assessed in this study.

Experimental study on characteristics of craniocerebral injury caused by handgun bullet impacting on bulletproof helmet / 中华创伤杂志

Objective To study the characteristics of craniocerebral injury caused by the handgun bullet impacting on the bulletproof helmet.Methods Fourteen healthy landrace pigs were involved and randomly divided into injury group(n =9)and control group(n =5).The landrace pigs of the injury group were shot vertically on the head under the protection of helmet plate with 9 mm handgun bullet at velocity of 360 m/s.While the landrace pigs of the control group were dealt with the same process as the injury group except for use of unarmed handgun bullet of the same ammunition dose.The changes of vital sign in the early period and the retina injury at two hours after injury were observed.Porcine cerebrospinal fluid (CSF)at pre-injury and at three hours post-injury were obtained for investigating the levels of neuron specific enolase(NSE)andαⅡ-spectrin protein.Then,the landrace pigs were sacrificed and dissected to examine the general morphological changes of the brain.The brain cortex was taken,fixed and stained with hematoxylin-eosin for microscopic observation.Results The landrace pigs in the injury group manifested decrease of the blood pressure and increase of the heart rate and respiratory rate in the early stage after injury.General morphological observation found retinal hemorrhage(3/9),skull fracture(3/9)and brain surface damage including local impact lesion(9/9)and contrecoup lesion(9/9),with severe impact lesion than contrecoup lesion.Optical microscopic observation revealed acute injury of the cerebral cortex neuron both on the impact and contrecoup locations.The concentrations of NSE and αⅡ-spectrinwere significantly increased in CSF three hours after injury(P ＜ 0.05).Conclusions The handgun bullet impacts on the pig head protected by the bulletproof helmet may induce blunt craniocerebral injury in the early period,with severe impact lesion than contrecoup lesion.Therefore,traumatic brain injury of the soldiers armed with the helmets should be stressed and managed early.