Pediatric Frontal Bone and Sinus Fractures: Cause, Characteristics, and a Treatment Algorithm

Area of Science:

• Pediatric Neurosurgery
• Craniofacial Trauma
• Pediatric Traumatology

Background:

• Frontal bone fractures in children are a significant concern.
• Understanding their incidence, causes, and characteristics is crucial for effective management.

Purpose of the Study:

• To assess the incidence, cause, characteristics, presentation, and management of pediatric frontal bone fractures.
• To classify fracture types and identify predictors for operative management and length of stay.

Main Methods:

• Retrospective cohort review of 174 pediatric patients (under 15 years) with frontal fractures from 1998-2010.
• Classification of fractures into three types based on anatomical characteristics.
• Review of charts and CT images to record fracture cause, demographics, management, injuries, and complications.

Main Results:

• Type III fractures were most prevalent (n=75), followed by type I (n=52) and type II (n=47).
• Operative management rates varied by fracture type (14/52 Type I, 9/47 Type II, 24/75 Type III).
• 11 children with nasofrontal outflow tract involvement underwent cranialization.

Conclusions:

• Type I fractures managed per standard neurosurgical guidelines.
• Type II fractures managed operatively for significant displacement or neurologic indications.
• Type III fractures managed operatively for similar indications plus nasofrontal outflow tract involvement; cranialization recommended for such cases.