Fronto-ethmoidal fractures: A staging system and case series analysis

Background

Fractures of fronto-ethmoidal bones (FEFs) are treated by a surgical team. A staging system for classifying FEFs is of paramount importance in order to plan surgery, to define prognosis and to exchange information among trauma centers. Some classifications are available but they are quite complex. Here a simple stage is proposed.

Methods

Five types of FEFs are possible: in situ FEF (without fragment dislocation, dura laceration or cerebrospinal fluid leak), type I (dislocated fracture involving the outer cortical bone, i.e. anterior frontal sinus wall), type II (dislocated fracture involving the inner cortical bone – i.e. posterior frontal sinus wall – and/or structures comprised in the diploe – i.e. the sinunasal tract), type III (dislocated FEF with dura laceration and cerebrospinal fluid leak), and type IV (i.e. comminuted fronto-ethmoid-orbital fractures). To evaluate the suitability of the proposed classification a retrospective study on a series of 42 patients was performed. Age, gender, stage, clinical diagnosis at admission, type of surgery and outcome were considered.

Results

A good correlation between the proposed classification and the studied variables was detected.

Conclusions

The proposed classification (that is a simplification of the Ioannides’ system) is a simple and precise method for staging FEFs. It can be used in daily practice. It is our understanding, however, that a multi-center study should be performed before the effectiveness of the proposed classification can be clearly stated.