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. [6, 20]
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. [21] 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. [9]
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.
Mouthguards have been shown to prevent some facial injuries; however, no evidence supports them preventing concussions. [22]
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The bony walls of the orbit.
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Le Fort fractures.
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Mandibular fractures.
