E-Scooter-Related Maxillofacial Fractures: A New Emerging Epidemic During the COVID-19 Period in the Province of Rome, Lazio, Italy: A Monocentric Study Review of 843 Patients Compared With the Pre-COVID-19 Two-Year Period.

INTRODUCTION: Shared vehicles, such as e-scooters and electric bicycles, could potentially accelerate the transition toward sustainable mobility. Focusing on e-scooters, the aim of this study is to show, compared with previous years when e-scooter use was significantly reduced, the increased incidence of maxillofacial bone injuries from e-scooters and the most frequent type of fractures. METHODS: We conducted a monocentric observational retrospective and prospective analysis during the pandemic, from January 1, 2020, until December 31, 2022, on patients' access for maxillofacial traumas at the San Giovanni Addolorata emergency department, trauma hub center, for Lazio district. A total of 383 patients were included. Data on the causes of traumas, type of injury produced, age, gender, nationality, and helmet use were collected. Especially, we analyzed the e-scooter-related facial traumas that had gained a lot of popularity in this period due to the restriction in mobility because of Covid-19, subsequent reduced use of public transport, and the new benefits introduced by the government for e-scooters or bikes. We compared e-scooter facial trauma with all the other kinds of facial fracture etiologies during this period. RESULTS: In our study, the most frequent causes of trauma were assaults (32.6%), accidental falls (24.2%), and sports activities (7.8%). The percentage of trauma among road traffic injuries was almost 24% of the total; in particular, motorcycle/e-scooter traumas was 7.1%, car crashes was 5.5%, pedestrian hits was 4.2%, and bike accidents was 3.1%. Other causes detected were syncope (5.5%), accidental traumas (1.8%), and epileptic crisis (1.1%). Focusing on road traffic injury access in our emergency department, compared with those between 2017 and 2019, it emerged that e-scooter-related facial traumas in the past two years have had a remarkable rise. In fact, there was a total of 27 patients (52% male and 48% female) instead of 5 between 2017 and 2019. The average age was 29 years. The most frequent types of e-scooter-related fractures were those to the nasal bones (29.7%), followed by mandibular fractures (unifocal 7.4%, bifocal 18.5%, trifocal 7.4%, and condylar 7.4%), zygomatic-maxillo fractures (18.4%), complex fractures (7.4%), and maxilla (3.7%). Among 27 observed electric scooter riders, nobody wore a helmet. CONCLUSIONS: Injuries associated with the use of e-scooters are a new phenomenon and mainly affect the craniofacial region due to the dynamic nature of the trauma. Although these vehicles have become increasingly common over the years and accepted within regulatory frameworks, the traffic rules are not ready to integrate e-scooters into the transport systems due to the lack of adequate legislation, and the lack of implementation in the form of facial safety devices or safety skills training for e-scooter riders.

Management of Orbital Medial Wall Fracture With Endonasal Balloon.

Medial wall fracture of the orbit is a condition that requires surgical correction should the patient presents a series of signs and symptoms such as diplopia and enophthalmos. The classical external approaches for exposure like the transconjunctival or transcutaneous approach have been replaced in specific cases by endoscopic approaches as they are less invasive and they eliminate any risk of potential scarring. Larger defects where the medial wall is comminuted or bony fragments are missing could be reconstructed with permanent autogenous or alloplastic materials. When bony fragments are present, a reduction of the fracture can be performed instead, with only a temporary alloplastic material for support. In this study, the authors discuss our experience regarding the management of orbital medial wall fractures by endoscopic endonasal balloon in 14 patients and describe its indications and contraindications. The authors concluded that the balloon achieves satisfactory mechanical support for the fracture to heal and it can be easily removed on an outpatient basis.

Frontal bone fractures: new technique of closed reduction.

Fractures of the nasofrontal orbital complex account for 5% of all facial fractures. Mean hospitalization is usually longer than for other types of facial lesions, independent of the trauma responsible (road accidents, sport, falls, firearm wounds, and so on). The choice of treatment, usually dictated by the site and extent of the damage, is important because inadequate treatment may lead to immediate or subsequent complications. A conservative surgical technique for use in the treatment of non-comminuted frontal lesions is described, which consists of the closed reduction of the depressed fragments by means of a small percutaneous approach. Before surgery, a computed tomography scan is carried out with 2-mm slices both in the axial and coronal projections, mandatory to evaluate the orbital roof and frontal region. The peripheral limits of the frontal region fracture are marked on the skin, a punctiform incision made in the area of maximum depression, and a calibrated drill inserted. Two small holes are created in the center of the depressed fragment and two pins screwed in, both of a length to allow the surgeon an easy reduction maneuver. A radiographic evaluation is then performed to check the correct alignment of the previously depressed fragment, the two percutaneous pins removed, and two sutures applied, if necessary. This technique avoids the scarring often observed after the open reduction technique and, in selected cases, treatment may be carried out in neuroleptanalgesia reducing operating as well as hospitalization times and healthcare costs.