Management of windshield facial injuries

Between Jan. 1986 and Dec. 1990, 99 patients with automobile windshield facial injuries were hospitalized in Kaohsiung Medical College hospital. All patients were injured by old type windshields in car accidents. Seventy-three patients (74%) were male and twenty-six (26%) were female. Ages ranged from 6 to 62 years (mean age 31 years). Fifty-seven patients (58%) were car drivers and forty-two (42%) were front seat passengers. All patients had typical multiple U-shaped lacerations on the face. The major injury sites were localized to the upper one third of the face. The wounds were repaired immediately after careful debridement. A total of 21 facial bone fractures were noted. All were open fractures with large, deep avulsion wounds. Displaced and comminuted fractures received reduction and fixation before wound closure. Three patients had cranial bone fracture with no displacement. Brain edema and subarachnoid hemorrhage were found by brain CT scan in two and one patients respectively. They were treated conservatively. In one patient with frontal sinus fracture the glass pieces penetrated into the brain. The foreign bodies were removed from the brain and frontal sinus. Eyeball rupture was found in 16 patients, including two patients in whom both eyes were involved. Eight eyeballs needed immediate evisceration and ten eyeballs received reparation. Blindness occurred in all these patients. Of the 99 patients in this study, 15% sustained additional injury. Most were wounds on the extremities. Because serious injuries can be caused by the old type of windshields, it should be abandoned. Driving with the seat belt fastened is the best way to insure safety.