Frontal Fracture Treatment & Management

  • Author: Thomas Widell, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Nov 17, 2011
 

Prehospital Care

  • ABCs are first priority. Hold airway open by chin lift, jaw thrust, or airway adjuncts, including endotracheal intubation.
  • Because of concerns over intracranial placement of endotracheal tubes, avoid using the nasotracheal route for intubation if the patient has extensive facial damage or midface fracture is suspected.
  • Place the patient on a backboard with a collar if cervical spine injury is a possibility.
  • Treat hypoventilation with intubation and bag ventilation.
  • Control actively bleeding wounds by applying a bandage with direct pressure.
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Emergency Department Care

  • ABCs take priority; reassess airway frequently.
  • Do not focus solely on the obvious deformity, thereby failing to perform a complete primary survey.
  • Rapidly diagnose other life threats and undertake appropriate resuscitation. Follow with a complete secondary survey.
  • Diagnosis of frontal bone fracture in the ED is part of secondary survey.
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Consultations

  • If a frontal fracture is diagnosed, refer patient to a neurosurgeon, as these injuries often are associated with intracranial injury.
  • Provide care for a patient with multiple injuries in conjunction with a surgeon experienced in trauma care.
  • The incidence of posttraumatic stress disorder is high in patients with facial injuries, and a consultation with a psychiatrist should be considered.[14]
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Contributor Information and Disclosures
Author

Thomas Widell, MD  Vice Chairman, Assistant Professor, Department of Emergency Medicine, Rosalind Franklin School of Medicine/The Chicago Medical School, North Chicago, Illinois; Associate Residency Director, University of Chicago Emergency Medicine Program, Chicago, Illinois; Program Director Emergency Medical Education, Attending Physician, Mount Sinai Hospital Medical Center, Chicago, Illinois

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD, FACEP  Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Hendler BH, Rosen P. Maxillofacial trauma. In: Rosen P, ed. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998:1093-1103.

  2. McGill J, Ling L, Taylor P. Facial trauma. Diagnostic Radiology in Emergency Medicine. Mosby-Year Book; 1992:51-76.

  3. Smith RG. Maxillofacial injuries. In: Harwood-Nuss A, ed. The Clinical Practice of Emergency Medicine. Lippincott Williams & Wilkins Publishers; 1991:337-43.

  4. Sullivan W. Trauma to the face. In: Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. Lippincott, Williams & Wilkins; 1996:242-69.

  5. Thomas SH, Shepherd SM. Maxillofacial injuries. In: Harwood-Nuss A, ed. The Clinical Practice of Emergency Medicine. Lippincott, Williams & Wilkins; 1996:408-18.

  6. Hasan N, Colucciello SA. Maxillofacial trauma. In: Tintinalli JE, Gabor KD, Stapczynski SJ, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw-Hill Co Inc; 2004:chap 257, p1583-1590.

  7. McKay MP. Facial trauma. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine, Concepts and Clinical Practice. Vol 1. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006:382-98/chap 39.

  8. Muminagic S, Masic T, Babajic E, Asotic M. Managment of frontal sinus fracture: obliteration sinus with cancellous bone graft. Med Arh. 2011;65(4):250-1. [Medline].

  9. Kummoona RK. Missile War Injuries of the Face. J Craniofac Surg. Nov 5 2011;[Medline].

  10. Kolodziej MA, Koblitz S, Nimsky C, Hellwig D. Mechanisms and consequences of head injuries in soccer: a study of 451 patients. Neurosurg Focus. Nov 2011;31(5):E1. [Medline].

  11. Guo L, Guo W, Li R, Sheng L, Yang B, Tang W, et al. Analysis of maxillofacial injuries caused by the 2010 Yushu earthquake in China. Emerg Med J. Oct 13 2011;[Medline].

  12. Spoor T, Ramocki JM, Kwito GM. Ocular trauma. In: Wilson RF, Walt AJ, eds. Management of Trauma: Pitfalls and Practice. Lippincott, Williams & Wilkins; 1996:225-41.

  13. Snell RS, Smith MS. The face, scalp, and mouth. In: Clinical Anatomy for Emergency Medicine. Mosby-Year Book; 1993:206-241.

  14. Glynn SM, Asarnow JR, Asarnow R, et al. The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital. J Oral Maxillofac Surg. Jul 2003;61(7):785-92. [Medline].

 
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