Frontal Bone Fractures: an increasing trend in contact sports injuries

Objectives: Frontal bone fractures are associated with high velocity injuries due to the significant force required to fracture the frontal sinus. The consequences of these fractures include undesirable contour deformities, as well as local infection of the frontal sinus, cerebrospinal fluid rhinorrhoea and potential intracranial complications. An increasing incidence of frontal bone trauma has been observed presenting to the National Maxillofacial Surgery Unit in St. James’s Hospital Dublin. The objective of our study was to characterise the demographics and sports most likely to be associated with the requirement for surgical reconstruction of the anterior wall of the frontal sinus.
Methods: The National Maxillofacial Unit maintains a contemporaneous record of all trauma involving the facial skeleton referred to the department. A retrospective review of this trauma database was performed and fractures were identified by applying a filter "frontal bone" to the data.
Results: 74 fractures involving the frontal sinus presented to the Maxillofacial Trauma Clinic in St. James’s Hospital over an eighteen-month period from October 2021, of which 62 (84%) occurred in males with an average age of 40 years. A total of 10 fractures (13.5%) were secondary to sporting collisions. The sports involved were as follows: Rugby (50%), Cycling (20%), Gaelic Football (10%), Soccer (10%) and Equestrian (10%).

7 (9.4%) male patients underwent open reduction and fixation of the anterior wall of the frontal sinus. 4 of these patients were young males, mean age 15.7 (14-17) years, in whom the injuries were sustained playing rugby. There were no reported associated symptoms of concussion.
Conclusions: The most frequently cited aetiology for patients undergoing surgical reconstruction was sporting injuries. Treatment of frontal sinus fractures presents complex surgical challenges and reconstruction may require significant intervention. This recently noted trend of young adult males sustaining fractures of the frontal sinus and potential intracranial injury from amateur sports, in particular rugby is concerning. This calls for increased education in schools and clubs for safe tackling techniques, strict disciplinary measures for foul play and vigilance.