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Do contemporary temporal bone fracture classification systems reflect concurrent intracranial and cervical spine injuries?

Authors

  • Gordon H. Sun MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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  • Nael M. Shoman MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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  • Ravi N. Samy MD, FACS,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
    • 231 Albert B. Sabin Way, MSB 6407, P.O. Box 670528, Cincinnati, OH 45267-0528
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  • Rebecca S. Cornelius MD,

    1. Department of Radiology, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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  • Bernadette L. Koch MD,

    1. Department of Radiology, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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  • Myles L. Pensak MD, FACS

    1. Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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  • This manuscript was presented as a poster at the Triological Society Combined Sections Annual Meeting in Scottsdale, Arizona, U.S.A., on January 27–29, 2011. Winner of the 2011 Francis Lederer, MD, Resident Research Award.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Temporal bone fractures (TBFs) are a frequent manifestation of head trauma. We investigated the prevalence of concurrent intracranial injuries (ICIs) and cervical spine injuries (CSIs) in a series of patients with TBFs and attempted to identify significant associations between current TBF classification systems and either ICI or CSI.

Study Design:

Retrospective case series with chart review.

Methods:

The records of all patients ≥18 years of age diagnosed with a basilar skull fracture, including TBF, at a level I trauma center from 2004 to 2009 were reviewed. Patient demographics, mechanism of injury, and Glasgow Coma Scale (GCS) scores were collected. Imaging studies were reviewed to classify TBF using the traditional longitudinal-transverse-mixed and otic capsule–sparing versus –involving systems and identify concurrent ICI and CSI.

Results:

Of 1,279 patients, 202 (15.8%) met inclusion criteria. There were 160 (79.2%) males. Sixteen (7.9%) patients had bilateral TBFs. Falls (n = 66, 32.7%) represented the most common mechanism for TBF. Longitudinal (n = 96, 44.0%) and otic capsule–sparing (n = 209, 95.9%) fractures were the most prevalent subtypes. There were 184 (91.1%) patients who sustained ICI and 18 (8.9%) who demonstrated CSI. Longitudinal, transverse, mixed, otic capsule–sparing, or otic capsule–involving TBF subtypes had no statistically significant associations with mechanism of injury, GCS score, or concomitant ICI or CSI.

Conclusions:

More than 90% of patients sustaining TBF presented with concomitant ICI, and 9% sustained CSI. Current TBF classification systems do not correlate with these outcomes. A more sophisticated, multidisciplinary classification system encompassing radiographic and clinical findings may better predict neurologic, neuro-otologic, and skull base complications.

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