Tragic Orland Bus Truck Accident

April 11, 2014

Our hearts go out to the parents and relatives of the High School students tragically killed and seriously injured in a Federal Express vs Tour Bus Accident near Orland on Thursday, April 10th.

The accident occurred when a tour bus was transporting the students from Southern California to Arcata to tour Humboldt State University.

Details are sketchy but it appears the Fed Express truck crossed the grassy center divider and slammed into the bus.

Fed Ex has over 280,000 employees and an enormous fleet of "18 wheeler trucks"

Fed Ex is a leading small package carrier and overnite delivery company. FedEx Drivers get compensated for making ontime delivery and are often in a hurry to get to the next stop,.

Any commercial truck driver in a hurry is necessarily a threat to public safety.

Its unknown at this point what led to the accident, but often factors involved include:

-Vehicle Equipment Failure, including brakes.
-Driver Fatigue or inexperience
-Poorly Loaded Trucks.

In all Trucking Cases, trucking companies immediately have teams investigating and on the scene and it is critical for families of the injured to have a representative who can get an investigator timely to the scene as well.

In a case like this the California Highway Patrol MAIT team will also make an extensive inquiry into causation,

The Law Offices of Edward A. Smith has extensive experience in representing families and individuals suffering severe injuries or death in trucking accidents.

Sacramento Car Accidents: Children on the Road

March 31, 2014

Children_playing_in_Vereda_del_Lago.jpgNo auto accident is more tragic than those involving children. It is incumbent upon everyone to act carefully when traveling to ensure that youngsters are protected from harm, whether that means - using proper child safety seats, slowing down in school zones, and keeping an eye out for kids running into the road.

Unfortunately, children throughout the area continue to be harmed in accidents on or near the roadway. In fact, auto accidents remain one of the leading causes of death for young children and teenagers.

Recovery Following Roadway Accidents

Under the civil law, all those who are harmed by the negligence of others can usually recover for their losses. In general, recovering after an accident requires the harmed person to show that another breached a duty of care (did not act reasonably) and caused the injury. The most hotly contested aspect of these cases is often determining whether a party actually acted unreasonably or did not do what a prudent person would have done in the same situation.

Determining carelessness is different for each case. That is because the vulnerabilities of the party harmed are often taken into account--that includes children. Children are held to a different and more limited standard of care during their encounters with motor vehicles on public streets. Unlike an adult pedestrian who has the duty to exercise ordinary care when encountering traffic or crossing the street, children must simply exercise that degree of care that would reasonably be expected of a child of like age, experience, and intelligence.

Therefore, in determining whether a child's actions amounted to negligence, the jury must first consider the age, mental capacity, and experience of the child. The ultimate question for the jury is whether the particular child, given her individual limitations, showed the level of care that reasonably should be expected of her. Everyone understands that children have yet to develop the maturity and awareness to avoid dangerous situations. That is why conduct that may been deemed reckless if performed by an adult pedestrian would be forgiven in a child.

In most cases, a driver who hits a child on or near the road will be found liable for the harm. For example, even in cases where a child darts out into the road unexpectedly, the driver's own negligence may have contributed to the accident. Perhaps the driver was speeding--speed limits are far lower in neighborhoods and school zones. At other times the driver may have been distracted by looking at a cell phone or otherwise not closely monitoring the road.

Car Accident Recovery

If your child was hurt in an accident on the road, it is critical to secure legal help as soon as possible. If your child has been injured in an accident, please call us for a free consultation. Call Ed at 916-921-6400.

Photo attributed to Wilfredor (Own work) [CC0], via Wikimedia Commons

Inflatable Bicycle Helmet

March 5, 2014

The U.S. National Highway Traffic Safety Administration reported 677 cyclists were killed and 48,000 were injured in motor vehicle traffic crashes in 2011. Wearing a helmet is the most effective means of protecting against a head injury. Unfortunately, fewer than half of cyclists wear them due to their unfashionable look and uncomfortableness. For cyclists who shy away from helmets, a Swedish company invented an air bag collar called the Hovding. The device is worn around the neck and has sensors that can detect a sudden change in speed or movements. If an accident is detected, the collar inflates with helium and forms an airbag protective cover around the head. Unlike most helmets it covers the neck as well as the head.

An Accident Attorney's Advice to his parents on Auto Insurance

February 27, 2014

As a trial lawyer practicing for over 30 years, I've been surprised at how many people over the years are totally confused about what car insurance covers and how much insurance they should carry.

My parents recently asked me about the types and amount of coverage they should have and I'll share with you the advice I gave them.

First, there is no such thing as "Full coverage". Most clients, when I ask them what they carry, say they have this..yet none know what it means. Neither do I.

Here are the main varieties of Auto Insurance in California.


This is insurance that protects you in the event that you are at fault in an accident.
It is usually sold in denominations such as 15/30, 25/50. 100/300 or 300/500.
What this means is that if you have 15/30 coverage, the most that your insurance will pay if you are at fault is $15,000 to one person or $30,000 to everyone that you cause injury to.

Since a night at UC Davis Medical Center can easily cost over $20,000, you are really taking a risk if you have a small sum of bodily injury coverage and you cause a serious injury. Your assets can be totally wiped out if the seriously injured person sues you and obtains a judgment far in excess of your policy.

My advice to most people is to carry a minimum of 50/100 bodily injury insurance no matter how little earnings and assets you may have.

For people in their 20's and 30's that own a home, I'd suggest a minimum of 100/300 insurance. For those of you earning in excess of $75,000 yearly and have been in your home for more than 2-3 years, I'd say a 300/500 policy would be appropriate.

And if you are in the top 10% income or assets wise, I'd buy a 300/500 policy with a UM Umbrella of 1 Million or more.

An umbrella policy will pay the other side if their damages are in excess of your underlying policy. Make sure to ask your agent if he sells a UM Umbrella because you want the additional protection it affords you as I will explain later.

95% of all umbrella policies DO NOT contain UM Protection so make sure to ask.


This coverage protects you if you or anyone in your car is injured by another driver who is at fault up to the amount of coverage you have. I suggest you obtain the same coverages for UM or UIM coverage as I suggested above for Bodily Injury Coverage.

The ways this works is as follows. If you are hit by someone without insurance (As many as 25% of all California drivers), your own uninsured motorist insurance covers you up to your UM limits.

If you are struck by a driver with minimum limits of 15/30 and you have very serious injuries worth say 500,000, you would first collect $15,000 from the other parties insurance and then an additional $485,000 would be available from your own underinsured motorist coverage.


This insurance pays medical bills of yourself or any passengers in your car regardless of who is at fault. I suggest everyone carry a minimum of $10,000 Medpay coverage because it is very cheap.

Even if you have health insurance you should buy Medpay because it protects others in your car who may not have health coverage and it affords everyone to get the best care and not necessarily what may be the substandard care of your health plan,


This will pay for property damage to any cars that are damaged up to the value of the policy. I normally suggest that people carry the sum of collision insurance suggested by their agent but with a good sized deductible if you can afford it.

For most cars, I'd suggest a $500 deductible but if the car is over 7 years old, you can really reduce your premium by selecting a $1000 or $2500 deductible.


Protects you if your car is damaged by a flood, storm, fire or vandalism. I suggest the same limits as the collision coverage,

"Gap Coverage"

This coverage I suggest when people buy new or almost new vehicles. It protects you from the situation which can arise when you drive a new car off the lot. Typically, the value of the car can decline 20% almost as soon as its off the lot.

If you're unlucky enough to have an accident at that time and your car is totalled, the other insurance (Or your own collision coverage) will only pay you the fair market value.

So if you piad $35,000 for a new car and get in a crash the next day, without "Gap coverage", you be out around $7000.

Some of you may worry that the sums of insurance I suggest here will cost you a fortune..but they won't! A 300/500 Bodily injury and UM policy will not cost 10X more than a 30,000/50,000 policy. Not even close.

You will pay a bit more for coverage, but you will be thankful if you are ever in a serious accident.

I gave the above advice to my parents and I give it to you as well.

Anyone having any question at all about auto insurance in California is always welcome to call me.

Knee Injuries in Motor Vehicle Accidents

February 20, 2013

Knee injuries in motor vehicle accidents are often called dashboard knee injuries because the person slips beneath the car restraints and slams their knees on the dashboard. There are many knee injuries that can occur in a dashboard injury. The patient can fracture their patella, the small disc shaped bone that covers the knee structures or can develop chondromalacia or a softening and damage to the cartilage beneath the patella. You'll often feel an achy knee as well as a grinding sensation when you walk with the knee. There can be ruptures of several ligaments within the knee, such as the ACL, MCL, LCL or PCL ligaments. The knee may become unstable and surgery may be necessary.

Common symptoms of knee injuries include a popping sensation in the knee, either at the time of injury or when you bend it later, redness, bruising or swelling of the knee, tingling of the knee, grinding or locking from pieces of cartilage being free floating or ripped within the knee, feeling unstable when you walk, or a deformity of the knee (in severe cases).

The types of injuries you can have with the knee include an anterior cruciate ligament tear or ACL tear. This stabilizes the knee and without an intact ACL you can often not walk and will have pain with the knee at rest that gets worse with motion. These can be isolated or can occur along with a tear in the meniscus. Surgery is usually necessary to repair this sort of injury.

You can also get posterior cruciate ligament tears. It is less common because this is a stronger ligament. It can be damaged during a severe dashboard injury or by falling on a knee that is flexed. A PCL injury is rarely isolated and is often coexisting with other injuries to the knee. It is the result of severe trauma.

A medial collateral ligament is the ligament most damaged in just about any knee injury, including motor vehicle accidents. It can be sprained, strained or torn. You can feel tearing or a ripping sensation, followed by swelling and bruising along the medial border of the knee. This type of injury is common in sports injuries as well as motor vehicle accidents.

The knee can become strained or sprained in a motor vehicle accident. It happens when the ligaments get stretched but not torn. All of the above ligaments can be strained or sprained, leading to pain, difficulty walking and a period of disability when it comes to walking on the knee.

It is estimated that about ten percent of all bodily injuries in a motor vehicle accident occur to the knee. Most of these injuries were not serious and represented sprains or strains. Most were as a result of frontal impact injuries and were associated with lacerations of the knee. Knee fractures usually happen as a result of high speed impacts and ligamentous tears occur in about 20 out of every 1000 motor vehicle injuries. Women are more likely to experience a contusion to the knee when compared to men. There has been little variation in knee injuries in spite of changes in the lap or three point restraining system.

If you were involved in a motor vehicle accident and need assistance, please call (916) 921-6400 for free, friendly advice.

Lower Extremity Injuries in Motor Vehicle Accidents

February 14, 2013

The good news is that restraints in motor vehicles have become optimized so people have a lesser incidence of upper body damage. Little attention has been paid to lower extremity injuries, however, in part because they do not cause mortality in general and they carry low injury scores. They do, though, cause a great deal of disability in those who suffer them. Not only is there a great psychological burden from lower extremity injuries but there is a longstanding possible disability. Other, unrelated injuries and factors like depression influence how the patient does long term.

A patient can sustain a foot injury from slamming the foot into the seat or footboard ahead of them. Foot injuries may or may not need to be casted but certainly they impair the ability of the patient to get around. It can mean days or weeks off the job until the individual can bear weight. Fortunately there are few long term disabilities from foot fractures.

Fibular_artery.pngTib/fib fractures are very common. These are fractures of the tibia and fibula, and can come from pressure pushing up from force on the bottom of the foot. It can also come from a direct force on the tibial and fibular area. Because the tibia is so close to the skin, an open or "compound" fracture can occur, leading to infection and poor healing. Tibial/fibular fractures can be healed through surgery that uses rods and plates to hold the bony segments together. It can also heal secondarily, with the body casted so that the bones knit together over time. A person with a tib/fib fracture can heal perfectly over 4-6 months of time or they can heal badly with one leg shorter than the other or an abnormal gait.

Femur fractures happen more often in children than in adults. It happens usually when forces below the femur put pressure on the femur and fracture it. It can fracture in the mid-shaft, leading to severe bony instability of the lower leg. The femur fracture is usually healed with rods placed surgically within the marrow of the femur. A person can walk much sooner with surgical correction of their femur fracture. It is rare to have the femur heal secondarily.

High on the femur is the hip. Hip fractures can involve fractures to the proximal femur or fractures to the ball of the ball and joint socket. In theory, a hip fracture can involve a fracture to the acetabulum or "socket" alone but then it is caused an acetabular fracture. Fractures of the hip come from forces directed upward from the foot at the time of the motor vehicle accident. There are many different types of hip fractures, depending on where the hip happens to break. These fractures need to be treated surgically, usually be removing the damaged hip and replacing it with an artificial hip and socket. In some cases, plates and rods are used to repair the hip.

Pelvic fractures carry some morbidity and mortality. They involve the bone within the pelvic region that rings the bladder and reproductive organs. There is generally a lot of bleeding with pelvic fractures that can cause shock to occur.

Lower extremity fractures are serious consequences of motor vehicle accidents. When they are associated with other types of trauma, they can be especially debilitating.

(Portrait attributed to Mikael Häggström via WikiMedia).

If you have a lower extremity fracture caused by a motor vehicle collision and need assistance, please call our office for free friendly advice at: (916) 921-6400.

Traumatic Brain Injury

February 13, 2013

There are many cases of traumatic brain injury in the US. In fact, there are more than 1.5 million traumatic brain injuries prevalent in the US and about 1.2 million ER visits, 290,000 hospitalizations and at least 50,000 deaths due to this devastating disease. Most traumatic brain injuries occur secondary to falls and motor vehicle injuries. These types of injuries occur when there is an external force on the brain causing brain dysfunction.


A violent blow to the head is the main cause of these types of injuries. It can also be caused by penetrating trauma, such as with a bullet or shrapnel. Brain injury types can be mild, moderate or severe. Fortunately there are many more mild injuries than severe injuries. Traumatic injuries to the brain can have a wide range of psychological and physical effects. Patients can have symptoms immediately after the injury or delayed symptoms.

In a mild brain injury, there may be no loss of consciousness or a loss of consciousness that lasts only a few minutes. There are immediate memory or concentration difficulties and a headache often occurs. There can be dizziness or vertigo associated with nausea and vomiting. Blurry vision or ringing in the ears is common and there can be sensitivity to light or sound. The person may develop anxiety or depression and may have mood swings. There can be fatigue or drowsiness and the person may have difficulty sleeping properly. On the other hand, the patient may sleep more than normal.

In moderate or severe traumatic brain injuries, the symptoms can be similar to milder injuries; however, the loss of consciousness can be many minute or even several hours. The period of confusion can be very long and the person may exhibit profound combativeness or agitation. Speech can be slurred and the person may be so injured that it is difficult to awaken them from sleep. There can be peripheral weakness or numbness and a lack of coordination. Vomiting can be repeated and the headache can be severe. Seizures are not uncommon and a professional evaluation can show dilatation of one or both pupils of the eyes. If there is a skull fracture, clear cerebrospinal fluid can drain from the ears or nose. There can be bleeding from the ear or nose as well.

Children can be injured as well and can have their own set of symptoms. There can be a sudden change in eating or drinking habits as well as persistent crying. The baby may be very irritable and difficult to console. The child's attention span can be poor and they may sleep too little or too much. The child may appear excessively sad and will have lost interest in the normal things in life.

The degree of damage depends on the type of event occurring and on the force of the impact. Injury can be located just to the area of impact or can cause multiple points of damage as the brain sloshes back and forth in the head. Rotation of the head can tear the cellular structures of the brain. An explosion can cause serious injury. Penetrating trauma can permanently kill off a section of brain, including blood vessels, brain cells and the dura of the brain. Any bleeding in the brain can cause swelling and blood clot that ruin the oxygen supply to the brain.

Head Trauma in Infants

February 13, 2013

Baby's_hand.JPG Head trauma accounts for more than 80 percent of death in children over the age of one year. In about 5 percent of situations, the child dies instantly from the trauma. Head injuries are complex, often requiring long stays in the hospital. There exists the need for approximately ten percent of infants requiring long term care with a medical facility after discharge.

Common causes of head injuries in infants and small children include assaults, motor vehicle accidents, child abuse and recreational activities. There can be a combination of primary injuries like scalp wounds, skull fracture, concussion, basilar skull fracture, subarachnoid hemorrhage, subdural hemorrhage and contusions.

There can be any one of the above primary injuries on top of many possible secondary injuries. Among the primary injuries, there can be a scalp injury. It can be overlying a skull fracture, called an open fracture of the skull. Scalp lacerations can be serious, especially in an infant as they can lead to hypotension and shock. A birth injury called the caput succedaneum is when there is a large blood clot between two layers of bone in the scalp. The blood loss is not as much because the bleeding stops at the suture lines.

A skull fracture in an infant can be linear, diastatic, depressed or comminuted. Ninety percent of all fractures are simply linear and may have an overlying laceration. Diastatic fractures have some distance between the fracture ends. There can be cerebrospinal fluid leaking through the laceration. A major blood vessel can cross over the open fracture, yielding a great deal of bleeding.

In a depressed skull fracture, an inner table of bone is pushing in on the brain. This is dangerous because it can damage the fragile brain tissue and can cause bleeding in the brain. This needs to be treated surgically so that the bony table can be at a normal level again. A third of depressed fractures are considered simple, a third cause a laceration of the dura covering the brain and a fourth have cortical lacerations.

A basilar skull fracture happens in up to 14 percent of pediatric head trauma patients. It occurs most whenever there is a blow to the back of the head. Symptoms that follow can include loss of consciousness, seizures and other neurological symptoms. Doctors may find a Battle sign or Raccoon eyes--areas of bruising that are indicative of a basilar skull fracture. Some of these finding occur in up to 10 percent of all cases of basilar skull fracture.

A concussion can occur if the head trauma is mild. Patients often show few signs of neurological damage; however, infants can show somnolence, vomiting and post traumatic seizures. Older children will exhibit post traumatic amnesia of the events after the concussion.

Brain tissue can be contused by the head trauma. This is caused by a direct blow to the head. The most vulnerable areas are the temporal and frontal lobes of the brain. Along with the contusion there can be edema of the brain and increased pressure around the brain which can result in death.

Handling a legal battle due to the death of an infant can be a painful process. It would be good to enlist a compassionate legal office to handle this matter for you. Please feel free to contact the Law Offices of Edward A. Smith to handle matters of this nature for you.

(Photo Attributed to Portraitlady4306 via Wikimedia Commons)

Closed Head Injury and Maxillofacial Trauma

February 11, 2013

Head_CT_scan.jpgIn some cases, patients sustaining trauma to the head and neck area will have both closed head injuries and maxillofacial trauma. Of the two, closed head injuries are more severe and need to be managed before the maxillofacial trauma is treated. Patients with closed head injuries can have intracerebral hematomas, subdural hematomas or epidural hematomas. Each of these blood clots can increase in size and can cause excess pressure on the brain. This can lead to semiconscious states or coma and, in severe cases, they can cause herniation of brain tissue through the foramen magnum at the base of the brain. Such a condition is almost uniformly fatal because the patient is unable to breathe on their own and have instability of pulse and blood pressure.

The recommendation of most physicians who suspect an intracranial injury when a maxillofacial injury is noted give the patient a CT scan of the head and face. This CT scan will determine the presence of bleeding, swelling and blood clots in the brain and will demonstrate any skull fractures or facial fractures. When the brain is stabilized through surgery or other modality, then the maxillofacial fractures, contusions and lacerations can be managed secondarily.

How many patients with maxillofacial injuries actually sustain cranial injuries on top of the facial injuries? One study looked at a hundred closed head injuries associated with the presence of facial fractures that were treated at a Level 1 trauma facility over a seventy-eight (78) month period. The facility was located in Northeastern Ohio. It was found that approximately 17.5 percent of patients with facial fractures also had closed head injuries. Males sustained closed head injuries four times more often than women with an age group predominance of about 16-30 years of age. About 59 percent fell into this age group. The most common cause of injury was a motor vehicle accident at 61 percent. While most injuries were sustained due to auto accidents, motorcycle accidents resulted in the most severe cases of head injury. There were more mandible fractures when compared to maxillary fractures with a ratio of 1.3 to 1. Facial fractures were found to have a similar incidence as in the non-head injured population at 14 percent but were associated with more severe intracranial injuries.

There is a greater chance of traumatic skull injuries when the facial fracture is closest to the skull. For example, if the maxilla or frontal bone is fractured, it can more easily extend up or back to include a fracture of the cranial bone. If the jaw is injured, there is less of a chance that the skull will be fractured, too. If a maxillofacial injury results in severe blunt trauma to the head, it can cause similar blunt trauma to the brain; brain injury is the result.

The combination head injuries and facial injuries which are severe and often require a team of neurosurgeons, ENT doctors, plastic surgeons and maxillofacial surgeons to take care of the head injury first, followed by any facial bone fracture and any facial soft tissue injury.

Of primary importance to those who suffer such severe injuries is their health. If you wish to alleviate the stress of your claim while recuperating from a severe injury, feel free to contact Law Offices of Edward A. Smith ( to assist you. The toll free number is (800) 404-5400.

Photo Attributed to Andrew Ciscel (Flickr) [CC-BY-SA-2.0 ( via Wikimedia Commons)

Children's Accidental Injuries

February 11, 2013

128px-Redheaded_child_mesmerized_2.jpgChildren's accidental injuries are one of the major causes of death to children all over the world. In fact, millions of children die each year from unintentional injuries. Such injuries can be as common as cuts and burns to those severe injuries injuries sustained by a pedestrian vs. auto collision. Progress in many countries has been made due to manufacturers recall of products, including toys, that are deemed unsafe. Additionally, many governments have mandated the use of things safety items such as car seats, safety belts in vehicles and bicycle helmets for children.

But there are still large areas of danger, such as pool injuries that result in drowning, the accidental swallowing of household cleaning products, getting burned by being in contact with a hot stove or oven, or being shot accidentally by a loaded firearm. Parents need to be vigilant in protecting children to make sure the environment is safe.

Unintentional injuries are one of the major causes of death and debility in millions of kids who live in developing countries. The inherent dangers of the living places, heavy traffic and a lack of a safe place to play are leading causes of injury in developing countries. Lack of appropriate childcare is another risk factor for childhood injuries. There is little access to emergency services and many can't afford access to emergency services if it existed.

In these countries, attention is paid to nutritional problems and communicable disease. In this area, child mortality numbers are going down. However, death due to injury is seen as a less significant problem in developing countries. Therefore, there is little research and attention paid to the issue of childhood accidents in some lands. Unfortunately, there is a tendency to think of unintentional injuries as something that is unpreventable. There is an immediate need for more research to understand the nature of childhood injuries in developing countries.

A study was done in Japan on the issue of childhood morbidity and mortality due to accidental injuries. The study was done on 4500 children ages 0-18 years of age who attended a specific emergency room in 1990. The number of patients who had injuries unrelated to traffic accidents was 243. This number was twice the number of children involved in traffic injuries (131 injuries). (Children with relatively ordinary injuries like cuts or scrapes were excluded from the total number of accident patients.)

The most common accidental injury was ingestion or inhalation of a foreign body. Most foreign bodies were ingested into the Gl tract. A total of 42 kids suffered from bronchial foreign bodies. Peanuts were the number one cause of inhalation of foreign bodies. In fact peanuts and other food like peanuts were ingested into the bronchial tree more than 80 percent of the time.

There were 38 cases in which a child nearly drowned and was therefore admitted to the hospital. Among the 38 cases just mentioned, five of the children died. Three of them suffered severe neurological sequelae. Thirty kids survived without residual injury. Bathtubs at home were the most common site of near drowning in young children.

These statistics are listed for educational purposes. They illustrate the real dangers that exist in our homes and the need for adults, governments, and schools to take action that would prevent these injuries.

Nonetheless, from time to time, incidents occur that do result in an injury to a child. If a minor you know has been involved in an incident resulting in injury, feel free to contact this office, Law Offices of Edward A. Smith, for advice on how to handle such claims.

(Photo Attributed to Steevven1, via Wikimedia Commons)

Craniofacial Trauma in Children

February 11, 2013

Craniofacial trauma in children involves any injury to the face, upper jaw bone, or skull. It can include skeletal injury, skin injuries and injuries to the neck, nose, eye socket, sinuses, teeth and other mouth parts. It is usually identified by a laceration, swelling or bruising of the facial tissue. Signs of fractures include bruising around the eyes, called Raccoon's eyes or behind the ear, called a battle sign. One can see a widening of the space between the eyes or teeth that are not in alignment. There can be bleeding from the nose, ears or mouth.

There are about 3 million people treated for facial trauma in United States emergency rooms. Of the children involved, 5 percent have suffered facial fractures. In kids under the age of three, most of them suffered their injury due to a fall. In kids over the age of five, motor vehicle accidents are the top cause of craniofacial injuries. This means that seatbelts and proper child restraints can reduce the risk of facial trauma.

Older children have other risks for facial injuries that include cheerleading, gymnastics, contact sports and cycling. Protective gear like helmets helps to reduce the risk of injury to the face. When accidents do occur, there is a great need to recognize and treat maxillofacial trauma in children as soon as possible. The development of their facial bones is greatly affected whenever there is poorly treated care of these types of injuries.

Facial trauma
is different in kids when compared to adults. The facial trauma can be minor or can be disfiguring throughout a child's life. It is a good idea to get the best possible treatment in kids, because their face hasn't fully formed and the treatment must be good enough to allow for proper growth and development of the face. Sometimes it takes a team of doctors to manage complicated facial injuries.

The types of facial injuries you'll see include soft tissue injuries or lacerations that can disfigure the face, especially if it involves nerves or cuts perpendicular to the lines of the facial skin. Bone injuries can involve the skull, the maxillary bone, the mandible, the zygomatic arch and the periorbital bones. Some of these can be left to heal on their own while others need surgery to correct misalignment of bones or open fractures, which need to be cleaned out extensively.

Isolated teeth injuries are common and may need the care of a dental specialist. If the teeth do not line up correctly, there must be a fracture of the maxilla or the mandible and these need to be corrected. A knocked out tooth must be placed in milk or salt water and then taken immediately to the emergency room where it can be replaced and temporarily cemented to keep it in place until it heals.

In one study, 750 children who sustained craniofacial injuries resulting from slips, trips and falls. It was found that the peak incidence of these kinds of falls occurred when a child was a toddler with straight falls happening when a child was under the age of one Most patients were in the preschool age group. These accidents happened at home 73-86 percent of the time. Lacerations occurred more in slips and trips than in straight falls.

Combined Craniofacial and Basilar Skull Fractures

February 11, 2013

Some patients are relatively lucky, getting only a basilar skull fracture or a maxillofacial fracture. While these are complex and difficult to treat, they are not as bad as having a combined maxillofacial fracture and basilar skull (skull base) fracture. Having this type of combined fracture requires a team approach of surgeons that can manage cranial injuries, orbital injuries, ENT injuries and other forms of maxillofacial injuries.

Often these types of injuries are initially overlooked because the patient has more life threatening injuries on other body areas. If these things are completely unnoticed, however, it can lead to diplopia, deafness, cerebrospinal fluid fistulae, cranial nerve injuries, meningitis or facial paralysis. It is therefore important to have early recognition and management of these injuries so that complications can be avoided. While thought of as less important fractures, there are cases of extreme morbidity and mortality associated with these injuries.

Maxillofacial fractures involve fractures of the zygomatic arch, fractures of the maxilla, the frontal bone, the nasal bone and the mandible. There are several distinct patterns of fracture that occur and that need surgical revision. Usually a maxillofacial surgeon, an ENT surgeon or a plastic surgeon manages these types of cases.

A fracture located at the base of the skull can be called a basilar skull fracture. This fracture can include parts of the skull like the temporal bone, occipital bone, ethmoid bone or the sphenoid bone. Basilar skull fractures are rare fractures to have, involving only 4 percent of cases of severe head injury. The fractures are dangerous because they can rip a hole in the meninges, resulting in leakage of cerebrospinal fluid from around the brain. The fluid leakage can dribble through a perforated ear drum causing otorrhea, or into the nasopharynx and out the nose. Both blood and fluid can drip out of the ear or nose. When the anterior part of the base of the skull is fractured, doctors can notice a halo sign.

Other signs of a basilar skull fracture include a Battle's sign, which is bruising behind the ears, Raccoon's eyes, which is periorbital bleeding or ecchymosis, cerebrospinal fluid rhinorrhea, bleeding from the nose and ears, blood behind the ear drum (hemotympanum), cranial nerve palsy, vomiting, nystagmus, and deafness. In up to ten percent of cases, there is entrapment of the optic nerve causing unilateral blindness. If the compression is mild and the fracture treated, there can be restoration of the vision over time. In serious cases, death can ensue.

When basilar skull fractures occur, there is a fracture in the posterior skull base or in the anterior skull base. The first type of skull fracture involves the occipital bone, the temporal bone and portions of the sphenoid bone. The second type involves parts of the sphenoid bone and ethmoid bones. Temporal bony fractures happen in 75 percent of all basilar skull fractures. This is the bone that extends up and includes the ear. This is when you get a hemotympanum or leakage of CSF from the ear.

Nasal Injuries

February 8, 2013

Nasal injuries can occur in the context of violence, motor vehicle injuries, sports injuries and falls. There can be blunt trauma, lacerations, avulsions and fractures as a result of these injuries. Some of these injuries can lead to surgical intervention. Secondary revision surgery or autogenous grafts may be necessary. It may take a multidisciplinary surgical team to manage the injury. The nasal bone may need to be reconstructed and avulsions may need to be grafted if not enough skin is covering the wound.


Nasal fractures are the most common facial fractures one will see. They are often not recognized and aren't treated at the time of the injury. Because the nose sticks out and because it is in the middle of the face, it is predisposed to being injured when the face is injured. Most nasal fractures tend to involve the nasal septum, which is a problem when it comes to a successful reduction of the fracture.

Fractures can be open or closed, depending on whether or not the mucosa is broken open. It is important to identify whether or not the fracture is open because infection can occur in open fractures and need antibiotics. Doctors need to determine if there is a septal hematoma and evacuate the hematoma if present. Failure to do that can cause erosion of the hematoma into the septal bone. Infections can happen with nasal septal hematomas.

Nasal fractures are the third most common of the various fractures one can get. The first and second most common fractures are clavicle fractures and wrist fractures. Other common facial fractures are zygomatic arch fractures at 22 percent, blowout fractures at 12 percent, mandibular bone at 8 percent and maxillary bone at 9 percent of facial injuries. A study of more than 200 patients showed that fractures of the nasal bone were the most common fracture sustained in sports injuries. Nasal septal injuries are on the rise now that airbag use is on the rise.

In kids, nasal fractures are most commonly because of falls. One must always consider the possibility of child abuse in all children who present with a nasal bone fracture. The major clinical findings in adults and children of a nasal bone fracture are a change in the nasal appearance, bleeding from the nose (especially if the mucosa has been disrupted), infraorbital bruising and a change in nasal appearance.

If the nasal fracture has severely abnormal nasal function, an abnormal appearance and the presence of early post injury complications, there is a possible need for surgery. There are a lot of different ways to do internal and external reduction and fixation so the nose looks and behaves normally.

For example, closed reduction can be done under local anesthesia with or without mild sedation, especially if the nasal bone fracture is simple or there is a combination simple nasal bone and septal fracture.

If there is open reduction, there needs to be general anesthesia. This should happen whenever there is extensive fraction-dislocation of the nasal bone and septum, fracture dislocations of the caudal septum or in cases of open septal fractures.

Management of Craniofacial Trauma

February 7, 2013

Maxillofacial and cranial trauma are common phenomena in severe motor vehicle accidents or falls from great height. There is a large variety of traumas that can happen, from facial fractures, cranial fractures and fractures that extend from the cranium to the facial bones, called cranio-maxillofacial fractures. One study looked through a large computerized database to see which kinds of injuries were seen under which conditions of injury. They looked at a period of 10 years from 1991-2000 and found 9,500 patients who were admitted to the hospital following cranio-maxillofacial injuries. They were all treated at the University of Innsbruck hospital.


Doctors and researchers looked at the cause of the injury, the gender and age of the patient, the mechanism and type of injury, the presence of soft tissue trauma in the patient and the presence of dentoalveolar trauma, facial fractures and nonfacial injuries.

The researchers found five major categories of trauma in these patients. In a total of 38 percent of cases, the injury happened as part of daily life. In 31 percent of injuries, the mechanism of injury was sports; in 12 percent of cases, it was violence that caused the injury; 12 percent were motor vehicle accidents causing maxillofacial trauma; in five percent, it was a work injury that caused the facial injury. Two percent were miscellaneous types of injuries.

Approximately 3600 patients or 37.5 percent had facial bone fractures and 4800 or so had dentoalveolar fractures. This was about 50 percent of all patients treated at the hospital for these types of injuries. Soft tissue injuries were common at 7800 injuries. There was a male to female ratio of more than 2 to 1 and the mean age was 25.8 years but both of these factors varied greatly, depending on the injury mechanism. For example, there was a higher risk of facial bone fractures in men, an equal risk of soft tissue injury in men and women and a higher incidence of dentoalveolar facial trauma in women.

Those who had facial trauma tended to get facial bone fractures at 22 percent, soft tissue lacerations and other lesions at 58 percent and more dental trauma among those who were injured during life and play activities. The probability of sustaining a soft tissue injury and trauma to the teeth was highest in sports activities such as football, soccer and other team sports. The rate was about 12-16 percent of the time.

The researchers used this information to tell craniofacial surgeons what kind of injury to expect and which kinds of injuries go together depending on the circumstances of the accident. They also felt that the government should consider legislation that helps prevent these kinds of preventable injuries from happening. Most victims were young and many were involved in sports-related trauma so that they could be required to wear facial and dental protection while playing sports or participating in other high risk activities.

In facial trauma, the older person represents only about 4.4 percent per year of age. They are more prone to getting facial fractures when compared to soft tissue injuries that only increase 2 percent per year of age. Younger people are much more prone to getting dentoalveolar trauma with a decrease of 4.5 percent per year of age.

Pediatric Injuries

January 31, 2013

Injuries are common in children and are one of the leading causes of death for kids age 0-18. They can, however, be prevented by understanding what injuries are more common in the different age groups. It may take instruction of healthcare providers, parents, and the children themselves to prevent these injuries from occurring. In addition to the family's financial burden, childhood injuries lead to emotional trauma for parents, society and the child himself.

In one study, a look at the morbidity and mortality of injuries in childhood was used to determine intervention strategies for kids at different developmental levels. They used data from 1996-1998 at a California hospital and by means of death certificate to determine the external cause of injury for children less than 4 years of age. Rates of death and injury were calculated at three month intervals.

There were a total of more than 23,000 injuries and 636 deaths. The annual rate for kids aged 0-3 years of age was 371 per 100,000 population. The rate increased dramatically after 5 months of age, peaking at ages 15-17 months of age. The leading causes of injury were poisoning, falls, automobile, fires or burns and foreign body injuries. Falls made up the greatest proportion of injuries.

The rates of injury for babies aged 0-12 months varied with age. They included falls from a height at 0-2 months, battering at 3-5 months, falls from furniture at 6-8 months and non-airway foreign body ingestion at 9-12 months of age. Hot liquid or vapor injuries were the top injuries in 12-17 months and poisoning by medication was the leading specific injury cause for children of ages 18-35 months and pedestrian injuries peaked at 36-47 months.

Falls from furniture had the highest rate from 3-47 months of age. Kids fell from stairs at under 12 months of age and medication poisoning topped at 21-23 months. Alternative substance poisoning peaked at a younger age, 15-17 months. Falls from buildings was greatest at two years of age. Motor vehicle injuries were steady over the age periods looked at. Both battering and neglect injuries were highest among infants less than 5 months of age. Bathtub submersion rates peaked between 8 and 11 months.

The researchers concluded that the type of injury sustained by the child was dependent on his or her developmental stage. In other words, kids that are ambulatory are much more likely to suffer from falls down stairs or pedestrian injuries when compared to kids that aren't ambulatory. Kids 15-17 months of age overall had the highest injury rate when compared to all kids until the age of 15 years.

They determined that when a child has the developmental ability to get into a hazard but has not developed the awareness that the hazard is dangerous is when the child is at the greatest risk of injury or death from trauma. They were surprised at the high rate of battering at such a young age, necessitating education on this problem in the perinatal period. Medication storage practices also need to be discussed and parents need to make use of poison control advice over the phone through the nationwide poison control system. Pedestrian injuries nearly doubled between 12 months and 17 months, indicating the need for education of parents over kids on or near roadways and driveways.