Epidemiologic 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, 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 CT-confirmed facial fractures (2016–2021), stratified into <20, 20–64, and ≥65 years. Fracture sites, mechanisms, and management (conservative, closed reduction, ORIF) were recorded. Group differences used chi-square/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%). Zygomaticomaxillary complex (ZMC) and orbital fractures increased with age (ZMC: 10.3%, 20.7%, 30.8%; orbital: 14.2%, 25.6%, 28.1%). Mandibular fractures were more frequent in younger patients (11.6% vs 5.7% in ≥65). 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 OR = 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.