Patterns and trends in facial fractures in New Zealand

Abstract

Intro: Fracture of the human facial skeleton is a common injury that places serious burden on society. Severe morbidity, mortality, facial disfigurement, loss of function and financial cost are all associated with facial fractures (Kieser et al., 2002). In New Zealand (NZ), only two previous studies have looked at the aetiology, incidence, age, gender and ethnic distribution of facial fractures at a national level; the most recent was conducted in 1998. In addition, approximately 40% of facial fractures in NZ involve the consumption of alcohol (Adams et al., 2000; Buchanan et al., 2005; Lee and Antoun, 2009; Tong et al., 2010). The legal purchasing age of alcohol in NZ, was lowered from 20 years of age to 18 years of age in December 1999. To date, no research has investigated what influence lowering the legal purchasing age of alcohol has had on the trends and patterns of facial fractures.

Aims: To describe the aetiology, incidence, age, gender and ethnic distribution of facial fractures in NZ from 1999 to 2009. To review the patterns and trends of facial fractures occurring in NZ from 1999 to 2009 with those previously identified. To identify whether lowering the legal alcohol purchasing age has influenced facial fractures. To identity whether Māori still experience a disproportionate risk of facial fractures with respect to other NZ ethnic groups.

Materials and Methods: This was a retrospective study investigating data on facial fractures that occurred between 30th June 1999 and 1st July 2009. Data were gathered from the Ministry of Health (MOH) and the Accident Compensation Corporation of New Zealand (ACC). Patient demographic characteristics and the details of injury (including alcohol involvement) were analysed and described.

Results: Over the study period, the incidence of facial fractures was constant and a total of 26,637 were coded by the MOH. Most facial fractures (78%) occurred in males, giving a male-to-female ratio of 4:1. Comparison of data for the period 1979 to 1998 highlighted that peak injury rates, especially in males, coincide with the legal alcohol purchasing age at the time. Since 1998, more injuries have occurred in the younger NZ population, with peak injury rates shifting from 20 years to 18 years of age. Interpersonal violence (IPV) is the leading cause of facial fractures in NZ accounting for almost 40% of all fractures. In addition, the number of injuries attributed to IPV is increasing each year. Māori still continue to experience a disproportionate level of facial fractures, twice that of the NZ European population.

Conclusion: IPV is an increasing problem in NZ and contributes to a greater number of facial fractures each year. More measures are required to reduce the number of IPV-related injuries. Perhaps the most influential would be to return the legal alcohol purchasing age to 20 years. More is also required to reduce facial fractures in the high-risk groups of young adults, males, and Māori.