23-year-old male self presents to emergency following a fall whilst intoxicated with alcohol. He sustained injuries to his head and face
Examination reveals bilateral temporomandibular joint (TMJ) tenderness with tenderness and abrasion over the mentum. The patient is unable to open him mouth >1 finger breadth
Describe and interpret the CT images
here is an undisplaced fracture of the mandibular body at the symphysis menti (the midline).
There are bilateral comminuted fractures of the mandibular condylar head and neck with multiple displaced bony fragments.
There is bilateral anterior TMJ dislocation.
This fracture pattern is known as a ‘guardsman fracture’ or ‘parade ground fracture’.
It is caused by a fall on to the midpoint of the chin. It results in a fracture of the symphysis or parasymphysis of the mandible at the point of contact with the ground, force is then transmitted to the mandibular condyles causing fracture and dislocation.
This fracture is typically seen in epileptics, elderly patients and occasionally in soldiers (from a fall forwards due to syncope after prolonged standing on guard).
This patient was managed with reduction in theatre with an ORIF.
- Mudgal P. Guardsman fracture. Radiopaedia
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Emergency Medicine Education Fellow at Liverpool Hospital NSW. MBBS (Hons) Monash University. Interests in indigenous health and medical education. When not in the emergency department, can most likely be found running up some mountain training for the next ultramarathon.
Sydney-based Emergency Physician (MBBS, FACEM) working at Liverpool Hospital. Passionate about education, trainees and travel. Special interests include radiology, orthopaedics and trauma. Creator of the Sydney Emergency XRay interpretation day (SEXI).