Facial Fractures Follow-up

  • Author: Timothy J Rupp, MD, FACEP, FAAEM; Chief Editor: Craig C Young, MD   more...
 
Updated: Sep 12, 2011
 

Return to Play

Evidence-based research to recommend return to play for athletes who have sustained facial fractures is lacking. Studies have demonstrated that bone healing begins with an inflammatory reaction hematoma stage for up to 5 days following the fracture, followed by callus formation stage 4-40 days following the fracture, and the remodeling stage occurring 25-50 days after the fracture. Based on this healing schedule, it has been recommended that the athlete not participate in activity for the first 20 days following the fracture, light activity days 21-30, noncontact drills days 31-40, and lastly, full-contact training and game play after day 41. The exception to this rule is combat sports in which return to activity is recommended no sooner than 3 months following the fracture.[5, 14]

In fractures that involve or approximate the eye, visual acuity is the most important factor in return to play. Any unexplained loss of acuity needs a complete workup. The aforementioned 20/40 criteria to play still apply (see Sport-Specific Biomechanics). Any athlete returning to competition without complete bone healing needs adequate protection, such as a full face shield, modified batting helmets, extended hockey eye visors, or larger football face masks.

Athletes need to regain their confidence in returning to play. An athlete who has physically recovered may not be mentally recovered from the trauma of the injury and, thus, is at risk of further injury. This is often observed in baseball players hit in the face by a pitch or hit ball. Psychologic recovery from facial fractures can be assessed in controlled practice situations. A consultation with a sports psychologist may be necessary if difficulties linger.

Return-to-play recommendations are not affected after orofacial fractures.[15] In a report by Laskin, the author observed that more than 100,000 sport-related injuries could be prevented annually by wearing appropriate head and face protection.[8]

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Prevention

Adherence to the rules and guidelines established by the specific sports governing body is most important. Almost all eye injuries are preventable, but other fractures can and do occur in sports with high levels of physical contact. Visual acuity, protective gear, and adherence to the rules of the sport are the best ways to limit the risk of facial fractures.

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Contributor Information and Disclosures
Author

Timothy J Rupp, MD, FACEP, FAAEM  Associate Medical Director, Physicians Emergency Care Associates, Methodist Health System; Clinical Physician, Children's Medical Center of Dallas and Children's Medical Center at Legacy, Plano; Clincal Associate Professor, University of Texas Southwestern Medical Center at Dallas

Timothy J Rupp, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Steven J Karageanes, DO  Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System

Steven J Karageanes, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

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

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

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  8. Laskin DM. Protecting the faces of America. J Oral Maxillofac Surg. Apr 2000;58(4):363. [Medline].

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The bony walls of the orbit.
Le Fort fractures.
Mandibular fractures.
 
 
 
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