Assessment of Clinical Outcomes of Frontal Bone Fractures: A Prospective Clinical Study

The aim of this study was to evaluate clinical outcomes of frontal bone fractures.

This prospective institutional study was conducted on a group of 51 patients, of which 26 underwent operative intervention for open reduction and internal fixation of frontal bone and associated fractures from December 2019 to December 2021 with a follow-up period of 6 months. The inclusion criteria consisted of patients of age 18 years and above, belonging to ASA classes 1 and 2; having displaced or undisplaced frontal bone fractures; with/without associated facial bone fractures and with controlled systemic condition. Pre-operative variables included demographic data, classification of frontal bone fractures using Gonty's classification, presence of traumatic brain injury (TBI), fracture displacement, frontal depression/asymmetry, pre-operative paraesthesia and cerebrospinal fluid (CSF) leak if present. Intra-operative assessment included type of approach performed, and the management carried out. Post-operatively, correction of asymmetry and post-operative complications were assessed.

The patients were aged between 18 and 60 years with a peak incidence in the 3rd decade. Fractures were classified using Gonty's classification, and type 1 (ii) fractures (25.49%) displayed predominance over other types. Isolated inner table fractures (n = 2) were managed conservatively. Asymmetry was present in 10 patients (19.60%) and were managed surgically. All 9 patients (17.6%) with frontal sinus outflow tract (FSOT) involvement underwent surgical correction. Only 5 patients (9.8%) required neurosurgical intervention. A titanium mesh was preferred choice for fixation of outer table. Post-operative complications were observed as follows: paraesthesia (n = 7), infection at the incision site (n = 1), frontal headache (n = 12), frontal sinusitis (n = 1) and CSF leak (n = 1). The use of coronal approach showed good long-term cosmesis. A statistical significance was observed between pre-operative asymmetry and correction of asymmetry post-operatively (p-value = 0.004). There was a statistically significant association between pre-operative and post-operative GCS scores (p-value = 0.013).

Simple and complex frontal bone fractures were adequately managed in this study. Conservative management of undisplaced and minimally displaced frontal bone fractures showed good long-term results. Hence, adopting a more conservative approach unless indicated otherwise, results in favourable outcomes with minimal to no complications.