Mechanisms Matter: Intentional Injury and Its Impact on Pediatric Facial Fractures

INTRODUCTION: Pediatric facial fractures resulting from violent mechanisms (eg, assault, gunshot wounds, and stabbings) represent a distinct subset of trauma with unique epidemiologic and clinical implications. This study evaluates how violent mechanisms influence pediatric facial fracture patterns, management, and demographic disparities. METHODS: The authors retrospectively reviewed patients younger than 18 years with facial fractures, comparing violent mechanisms (VM) and nonviolent mechanisms (NVM). VM were defined as intentional injury inflicted by others or oneself. Patients were treated at a Level 1 trauma center between January 2006 and February 2025. Variables included demographics, fracture characteristics, surgical intervention, cervical spine injury, and traumatic brain injury (TBI). Categorical variables were analyzed using χ2 or Fisher's exact tests, and continuous variables with the Wilcoxon tests. Multivariable predictors of VM were assessed using logistic regression, adjusting for demographic and injury variables. RESULTS: Among 1845 patients, 320 (17%) sustained facial fractures due to VM. Most were male (86%) and African American (36%). Assault accounted for 63% of VM cases, followed by gunshot wounds (34%) and stabbings (3%). Male sex (OR 2.4, P<0.001), Hispanic ethnicity (OR 2.32, P<0.001), increasing age (OR 1.28/year, P<0.001), and mandibular fractures (OR 2.02, P<0.001) were independently associated with VM. Loss of consciousness was associated with lower odds of VM (OR 0.38, P<0.001). Violent injuries more often required operative management (54% versus 32%, P<0.001). CONCLUSIONS: Violent pediatric facial trauma is associated with higher operative rates, mandibular fractures, and disproportionate impact on older male adolescents. Recognition of these patterns may improve triage, imaging decisions, and timely surgical consultation.