TCB Question: Facial Fractures

After a great weekend in Lexington I came away with tons of questions, thought-provoking ones.  One question that I cannot seem to answer is in regards to facial fractures and how they relate to concussions.  Now before you go and vote below think about this.  Can you sustain a facial fracture, i.e. orbit, zygomatic, maxilla, mandible (anything other than nasal), and NOT get a concussion? Vote below then click on “read more” for my thought process…

If you think about it from a pure “physics” mindset it seems that it would be almost impossible.  The forces necessary to fracture a bone are exceedingly high, otherwise every time we were hit in the face by an innocent elbow or ball it would break, right?  Knowing this and the FACT that concussions are created at forces less than what is needed for a skull fracture wouldn’t it make sense that facial fractures would be associated with concussions?  Not to mention the vector of the forces that create a facial fracture are, a vast majority of the time, dynamic; including rotational and lateral vectors.

The underlying theme of the question is that in sports injury reports we often see listings like; “facial fracture”, “fractured orbit”, etc. (mainly in hockey and footy, some baseball) but we don’t hear about a concussion related to the injury.  This goes deeper than professional sports; what about the youth athlete diagnosed with a facial fracture but is never given information about concussion?  Are we ignoring an underlying injury because diagnostic imaging has us focused on the cosmetic injury?  I know I even excluded the nasal bone in the above question, but a lot of times a broken nose would be associated with rotational forces, there too may be another missed opportunity to find a concussion.

I would greatly appreciate comments about this question, for the time being I am going to dub this…

“Fink’s Rule”: when there is a diagnosed fracture of the face and jaw (excluding the nasal bone) the forces absorbed during the injury will be beyond a threshold to elicit a concussive episode.  This would indicate to the clinician that the person should ALSO be evaluated for a concussion.

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