An Analysis of 733 Surgically Treated Blowout Fractures

Abstract

Purpose: To evaluate current patient demographics and surgical outcomes from a large series of 733 surgically treated orbital fractures from an ophthalmologist’s perspective. Methods: We reviewed the medical records of 733 patients with orbital fracture, who were treated surgically by one of the authors at Gil Hospital, Gachon University, from May 2000 until September 2007. Data regarding patient demographics, signs and symptoms at presentation, cause of injury, nature of fracture, associated ocular and nonocular injury, surgical outcome and complications were collected. Results: Male patients outnumbered female patients, and blowout fracture occurred most frequently between the ages of 20 and 29 years (mean age 30.7 years). Violent assault was the leading cause of the fractures, followed by fall/slip and traffic accidents. Common signs and symptoms were periorbital ecchymosis, ocular motility restriction, diplopia and enophthalmos. In the pediatric group, diplopia and ocular motility restriction were the most common. Subconjunctival hemorrhage, hyphema and commotio retinae were the most commonly associated ocular injuries. As for the location of fractures, medial wall fractures were the most common, followed by fractures of the inferior wall, and both medial and inferior walls, in order. The most common type of fracture was the ‘comminuted’ one. In the pediatric group, the percentage of trapdoor-type fracture was higher than in the adult group. Forty-four percent of the patients had diplopia preoperatively and 8.7% postoperatively. The average measurement of difference in the enophthalmos (≧2 mm) patient population was improved from 2.62 (±SD 0.9) to 1.73 (±SD 1.3) after surgery. Ocular motility restriction was preoperatively noted in 297 patients (40.5%), and only 18 patients (2.5%) showed restriction after surgery. Conclusion: Young male individuals are at the highest risk for orbital fractures. There are marked differences in the clinical symptomatology and findings between pediatric and adult orbital fractures. Diplopia, enophthalmos and ocular motility restriction improved by repair of fracture.

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry

“…Two weeks are enough for the orbital hematoma and edema to subside or reduce and to prepare the patient for surgery Kwon et al divided orbital floor fractures into anterior, posterior and anteroposterior 12 . But there is a very large dispersion of functional results, 8.7-67%, especially in the persistence of postoperative diplopia 5,7,[13][14][15][16][17] . Worth noting is the contribution of CT-guided surgery, leading to the complete disappearance of postoperative diplopia.…”

Orbital blowout fracture location in Japanese and Chinese patients

“…Blunt trauma to the orbit commonly results in orbital blowout fractures involving the orbital floor or medial wall [1][2][3]. Pure orbital fractures tend to occur at the weakest point of the orbital wall, which has been shown in anatomic studies to be the lamina papyracea of the ethmoid (medial wall) and the floor of the orbit [4].…”

Clinical Follow-up Examination and the Patients’ Perception – a Comparative Analysis of Treatment Outcomes Based on a Study Performed Among Patients with Fractures of the Upper and Middle Thirds of the Facial Skeleton

“…The vast majority of patients presenting with this type of injury are men [5][6][7][8][9], most often young, aged 21-30 years [1,[10][11][12][13]. The main reason for fractures in this group is physical violence, commonly associated with alcohol or other psychoactive substances abuse [5,8,9,[13][14][15][16].…”