Epidemiological and Clinical Characteristics of Facial Bone Fractures across Age Groups: A Single-Center Retrospective Analysis of 4,975 Patients at a Regional Trauma Center in Gangwon Province, South Korea.

BACKGROUND: Patient age influences diagnosis, operative planning, and recovery in facial fracture care. We aimed to delineate age-dependent patterns in fracture sites, injury mechanisms, and management across pediatric, working-age, and elderly cohorts at a regional trauma center. METHODS: We retrospectively analyzed 4,975 patients with computed tomography (CT)-confirmed facial fractures (2016-2021), stratified into <20, 20-64, and ≥65 years. Fracture sites, mechanisms, and management (conservative, closed reduction, open reduction and internal fixation [ORIF]) were recorded. Group differences were tested using chi-square/analysis of variance (ANOVA) with Holm adjustment. Multivariable logistic regression identified independent predictors of operative management. RESULTS: The cohort was predominantly male (∼3:1). Nasal fractures were most common (42.3%) but declined with age (60.1%, 41.7%, 31.5%, respectively). Zygomaticomaxillary complex (ZMC) and orbital fractures increased with age (ZMC: 10.3%, 20.7%, 30.8%, respectively; orbital: 14.2%, 25.6%, 28.1%, respectively). Mandibular fractures were more frequent in younger patients (11.6% vs. 5.7% in patients aged ≥65 years). In the elderly, falls (slip/roll/fall-down combined 52.6%) predominated, whereas assault and sports were proportionally higher in younger groups. Mechanism was strongly associated with fracture site ( p  < 0.001). Operative treatment was less frequent in the elderly, in whom conservative care predominated. In multivariable analysis, increasing age independently predicted lower odds of surgery ( p  < 0.001), whereas multiple fractures were the strongest predictor of operative intervention (adjusted odds ratio = 2.50, p  < 0.001). CONCLUSIONS: Facial fracture patterns, mechanisms, and treatment differ by age. Findings support age-tailored prevention-fall prevention for older adults and high-energy injury mitigation for younger cohorts-and individualized strategies balancing functional priorities against systemic risk in the elderly.