Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 4, pp 1295–1302 | Cite as

Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries

  • Volker Krutsch
  • Markus Gesslein
  • Oliver Loose
  • Johannes Weber
  • Michael Nerlich
  • Axel Gaensslen
  • Viktor Bonkowsky
  • Werner Krutsch
Sports Medicine



The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury.


In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population.


The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected.


In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms.

Level of evidence

Level III.


Midfacial fracture Concussion Football Soccer Prevention Return-to-play 



We are grateful for the support of the Centre of Clinical Studies at the University Medical Centre Regensburg, the support by the ZNS-Hannelore-Kohl-Stiftung in Bonn/Germany and the “AG Prävention” of the German Society of Orthopaedic and Trauma Surgery (DGOU).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


This study received no funding to compete.

Ethical approval

The study design of this study was approved by the Ethical committee of the University of Regensburg (ID-No: 15-101-0134).

Informed consent

Patients gave informed consent prior to study inclusion.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Volker Krutsch
    • 1
  • Markus Gesslein
    • 2
  • Oliver Loose
    • 3
  • Johannes Weber
    • 4
  • Michael Nerlich
    • 4
  • Axel Gaensslen
    • 5
  • Viktor Bonkowsky
    • 1
  • Werner Krutsch
    • 4
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryParacelsus Medical University, General Hospital NurembergNurembergGermany
  2. 2.Department of Trauma SurgeryParacelsus Medical University, General Hospital NurembergNurembergGermany
  3. 3.Clinic for Paediatric Surgery, Clinic St. HedwigRegensburgGermany
  4. 4.Department of Trauma SurgeryUniversity Medical Centre Regensburg, FIFA Medical Centre of ExcellenceRegensburgGermany
  5. 5.Clinic Wolfsburg, Department of Trauma SurgeryWolfsburgGermany

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