Frontobasal fractures – Surgery or conservative treatment?

Introduction The treatment of frontobasal fractures often presents a challenge in clinical decision-making. While fractures with a dural injury or pronounced dislocations undoubtedly require surgical treatment, the indication for surgery in minor fractures without confirmed rhinoliquorrhea or fracture-related restrictions is not always as clear. This can lead to uncertainty in everyday clinical practice.

Material/Methods This retrospective, single-center study included 95 consecutive, surgically or conservatively treated cases of frontobasal fractures between 10/2017 and 09/2022. Pretherapeutic ß-trace protein detection in the nasal secretion as well as intraoperative findings regarding cerebrospinal fluid leakage were evaluated. There was also a follow-up by telephone interview.

Results In the evaluated cohort, 50 frontobasal fractures were treated surgically and 45 fractures were treated conservatively. In those treated surgically, the pretherapeutic ß-trace findings were registered for 22 patients, in 7 of which it showed a positive result. All of the latter had an intraoperatively detectable CSF leak. Intraoperatively, a dural injury was found in 3 patients and 5 Patients had cerebrospinal fluid leakage. Exposed dura without cerebrospinal fluid leakage was seen intraoperatively in 4 patients. Of the 45 conservatively treated frontobase fractures, the ß-trace finding was registered for 25 patients and was positive in 2 patients.

Summary The determination of ß-trace protein in nasal secretions correlates well with the intraoperative findings and allows for a reliable diagnostic clarification of possible rhinoliquorrhea. This can be a valuable decision-making aid in everyday clinical practice when it comes to the therapeutic measures of frontobasal fractures.

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Artikel online veröffentlicht:
19. April 2024