Maxillofacial injuries and orthopedic fractures are among the most common traumatic presentations in polytrauma cases, often requiring multidisciplinary management to ensure optimal patient outcomes. Polytrauma, defined as multiple severe injuries affecting different anatomical regions, is a significant cause of morbidity and mortality worldwide [1]. 

Maxillofacial injuries range from soft tissue lacerations and dentoalveolar trauma to complex fractures involving the mandible, maxilla, zygomatic complex, and orbit [3]. They often coexist with orthopedic fractures, particularly in the upper and lower extremities, pelvis, and spine, due to the high-energy mechanisms involved in polytrauma cases. Several studies have highlighted the correlation between facial fractures and concomitant skeletal injuries, emphasizing the need for thorough assessment in trauma patients [4]. The pattern and severity of these injuries are influenced by factors such as age, gender, mechanism of injury, and protective measures like helmet and seatbelt usage [5].

Epidemiological studies on the incidence and prevalence of maxillofacial and orthopedic injuries provide valuable insights into trauma trends, enabling healthcare professionals to devise better preventive strategies and treatment protocols. Previous reports indicate that maxillofacial fractures account for approximately 10–15% of all trauma-related fractures, with orthopedic fractures occurring in 25–40% of polytrauma patients [6]. However, the precise distribution of these injuries varies globally, depending on geographic location, socioeconomic conditions, and healthcare infrastructure [7]. Understanding these epidemiological patterns is crucial for resource allocation, training of medical personnel, and improving trauma care facilities.

The management of polytrauma cases presents unique challenges, as maxillofacial injuries often require coordinated care between maxillofacial surgeons, orthopedic surgeons, neurosurgeons, and critical care specialists. The choice of surgical intervention, timing of treatment, and rehabilitation strategies significantly impact patient prognosis. Advances in imaging techniques, including computed tomography (CT) and three-dimensional reconstruction, have enhanced the accuracy of diagnosis and surgical planning, leading to improved functional and aesthetic outcomes [8]. Moreover, recent developments in biomaterials, rigid fixation techniques, and minimally invasive procedures have revolutionized the management of these injuries, reducing morbidity and hospital stay [9].

Despite the growing body of literature on trauma epidemiology, there is a lack of comprehensive data on the concurrent occurrence of maxillofacial injuries and orthopedic fractures in polytrauma cases. This study aims to evaluate the incidence and prevalence of these injuries, identify common patterns and risk factors, and assess their impact on patient outcomes. By analyzing a large cohort of polytrauma patients, our research seeks to provide valuable insights for trauma surgeons, policymakers, and healthcare institutions to enhance preventive and therapeutic strategies [10].

This study is a prospective observational study conducted at a tertiary care trauma center over a period of 1 year. The study was designed to evaluate the incidence and prevalence of maxillofacial injuries and orthopaedic fractures in polytrauma cases, assess injury patterns, and determine associated risk factors. The study was approved by the Institutional Ethics Committee, and informed consent was obtained from all participants or their legal guardians before inclusion.

Study Population

The study included all patients presenting with polytrauma, defined as injuries affecting multiple anatomical regions with an Injury Severity Score (ISS) ≥16, who were admitted to the emergency department during the study period. Patients were included if they had documented maxillofacial injuries and/or orthopedic fractures confirmed through clinical and radiological evaluation. The exclusion criteria were:

• Patients with isolated maxillofacial injuries or isolated orthopedic fractures.
• Patients with minor soft tissue injuries without bony involvement.
• Patients who did not provide consent or were lost to follow-up.

Data Collection

A structured data collection form was used to record demographic details, injury mechanisms, clinical presentations, and radiological findings. The following variables were documented:

Demographic Data: Age, sex, occupation.

Injury Characteristics: Mechanism of injury (road traffic accident, fall, assault, sports injury, etc.), type and location of fractures, presence of associated injuries.

Clinical and Radiological Assessment: Physical examination findings, computed tomography (CT) scans, X-rays, and three-dimensional reconstructions were used to confirm fracture patterns and severity.

Management Details: Type of surgical or conservative management, duration of hospital stay, complications, and patient outcomes.

Diagnostic Criteria and Classification

Maxillofacial injuries were classified based on the Le Fort classification for midface fractures, the Zygomaticomaxillary complex fracture classification, and the Ellis classification for mandibular fractures. Orthopedic fractures were categorized according to the AO/OTA fracture classification system. The severity of polytrauma was assessed using the Injury Severity Score (ISS) and the Glasgow Coma Scale (GCS) for associated head injuries.

Statistical Analysis

The collected data were analyzed using SPSS version [Insert Version]. Descriptive statistics were used to calculate the incidence and prevalence of maxillofacial and orthopedic fractures. Categorical variables were analyzed using the Chi-square test, and continuous variables were compared using the Student’s t-test or Mann-Whitney U test as appropriate. A multivariate logistic regression model was used to determine risk factors associated with severe injury patterns. A p-value of <0.05 was considered statistically significant.

Ethical Considerations

The study included 250 polytrauma patients, with a predominant male population (72%) compared to females (28%). The mean age of the patients was 34.6 ± 12.4 years, indicating that trauma incidents were more common in young to middle-aged individuals. The higher proportion of male patients suggests their increased exposure to high-risk activities, including driving, outdoor work, and contact sports. Table 1

Table 1: Demographic Characteristics of Polytrauma Patients

The most frequent cause of polytrauma was road traffic accidents (RTAs), accounting for 60% of cases, followed by falls (20%) and assaults (12%). Sports-related injuries and other miscellaneous causes contributed 4% each. The high incidence of RTAs highlights the need for improved traffic regulations, road safety measures, and public awareness campaigns to reduce injury rates. Table 2

Table 2: Mechanism of Injury in Polytrauma Cases

Among the maxillofacial injuries, mandibular fractures (30%) were the most commonly reported, followed by maxillary fractures (20%), zygomatic fractures (16%), and orbital fractures (14%). In orthopedic injuries, long bone fractures were the most prevalent (40%), followed by pelvic fractures (12%) and spinal fractures (8%). The frequent occurrence of long bone fractures in conjunction with maxillofacial trauma suggests high-energy impact mechanisms, such as RTAs and falls from significant heights. Table 3

Table 3: Distribution of Maxillofacial Injuries and Orthopedic Fractures

Patients with higher Injury Severity Scores (ISS) had significantly longer hospital stays and higher mortality rates. Those with an ISS between 16-25 had a mean hospital stay of 7.8 ± 2.1 days and a mortality rate of 5%. Patients with moderate severity (ISS 26-35) had a mean hospital stay of 12.4 ± 3.5 days, with a mortality rate of 15%. In contrast, patients with an ISS >35 had the longest hospital stay (18.9 ± 4.7 days) and the highest mortality rate (30%). These findings underscore the importance of early intervention, multidisciplinary management, and aggressive trauma care in improving patient outcomes. Table 4

Table 4: Association Between Injury Severity and Length of Hospital Stay

Maxillofacial injuries and orthopedic fractures in polytrauma patients present significant challenges in trauma management, requiring multidisciplinary intervention to optimize outcomes. The present study analyzed the incidence and prevalence of maxillofacial injuries and orthopedic fractures in polytrauma cases, identifying key injury patterns, risk factors, and associations with severity and patient prognosis. The findings of this study align with global epidemiological trends, where road traffic accidents (RTAs) remain the leading cause of polytrauma [1-3].

Mechanism of Injury and Trauma Distribution

The predominance of RTAs (60%) as the primary cause of polytrauma is consistent with previous literature, which highlights the increased risk of severe trauma due to high-speed vehicular collisions, poor road safety measures, and non-compliance with protective gear [4]. The higher incidence of RTAs among males (72%) in this study further corroborates existing data, where men are more likely to engage in high-risk activities such as driving, high-speed travel, and hazardous occupational work [5]. Falls (20%) and assaults (12%) were also significant contributors, with falls being particularly common among the elderly and children, whereas assaults were more frequently associated with interpersonal violence [6].

The anatomical distribution of injuries in this study revealed that mandibular fractures (30%) were the most prevalent maxillofacial injuries, followed by maxillary (20%), zygomatic (16%), and orbital fractures (14%). Mandibular fractures are often associated with high-impact trauma, particularly in RTAs and direct facial impacts, which are commonly observed in young adult males [7]. In contrast, long bone fractures (40%) were the most frequent orthopedic injuries, reflecting the vulnerability of the extremities in high-energy trauma events [8]. The prevalence of pelvic fractures (12%) and spinal fractures (8%) highlights the severe impact of polytrauma, particularly in cases with high-force deceleration injuries [9].

Correlation Between Injury Severity and Clinical Outcomes

A key finding of this study was the direct relationship between Injury Severity Score (ISS) and hospital stay duration, with patients sustaining severe injuries (ISS >35) experiencing the longest hospital stays (mean 18.9 ± 4.7 days) and highest mortality rates (30%) [10]. This is in line with previous studies, where higher ISS scores have been linked to prolonged intensive care unit (ICU) admissions, increased risk of complications, and higher mortality rates [11]. Patients with moderate ISS (26-35) had a mortality rate of 15%, while those with milder injuries (ISS 16-25) had significantly better outcomes, with a shorter hospital stay (mean 7.8 ± 2.1 days) and a lower mortality rate (5%) [12]. These findings highlight the importance of early resuscitation, advanced trauma life support (ATLS) protocols, and timely surgical intervention in reducing morbidity and mortality in polytrauma patients.

Role of Imaging and Surgical Management

The use of advanced imaging techniques, such as computed tomography (CT) scans and three-dimensional reconstructions, has greatly improved the accuracy of diagnosing maxillofacial and orthopedic injuries in polytrauma cases [13]. In this study, CT scans played a crucial role in detecting complex fractures, particularly in the midface and orbit, which are often challenging to diagnose through conventional radiographs. The ability to precisely assess fracture displacement, soft tissue involvement, and neurovascular compromise has enhanced surgical planning and outcomes in trauma patients.

Surgical management remains the gold standard for displaced fractures, particularly in mandibular and zygomatic injuries, where rigid fixation techniques such as mini-plates and three-dimensional titanium meshes have improved functional and aesthetic outcomes. Similarly, in orthopedic trauma, internal fixation with plates, screws, and intramedullary nails has significantly reduced complications such as non-union and malalignment, leading to improved post-trauma recovery.

Clinical Implications and Future Directions

This study underscores the need for improved preventive measures, including stricter enforcement of traffic regulations, use of helmets and seat belts, and increased public awareness of trauma-related risks. Additionally, early rehabilitation and physiotherapy interventions are crucial in ensuring functional recovery, particularly in orthopedic injuries where prolonged immobilization can lead to joint stiffness and muscle atrophy.

Future research should focus on long-term functional outcomes, rehabilitation strategies, and the impact of early surgical intervention on overall prognosis in polytrauma patients. Moreover, incorporating artificial intelligence (AI) and machine learning algorithms in trauma imaging and risk assessment may further enhance early diagnosis and treatment planning.

The findings of this study provide valuable insights into the epidemiology, injury patterns, and outcomes of maxillofacial and orthopedic injuries in polytrauma cases. The strong correlation between injury severity and hospital stay duration highlights the importance of early intervention and multidisciplinary trauma care in reducing mortality and improving patient recovery. Strengthening preventive measures and optimizing trauma management protocols will be essential in mitigating the burden of polytrauma injuries in the future.

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