Are Inferior Rectus Muscle Displacement and the Fracture's Size Associated With Surgical Repair Decisions and Clinical Outcomes in Patients With Pure Blowout Orbital Fracture?

Abstract

Although orbital blowout fractures are common, there is no consensus with respect to treatment decision making and long-term outcome. The purpose of this study was to evaluate the association between inferior rectus muscle (IRM) displacement and fracture size and the surgical repair decisions and clinical outcomes in patients with blowout fractures (BOFs). Patients and Methods: We designed a prospective cohort study and enrolled all patients who presented to the University Hospital of Geneva for evaluation of a BOF. The primary predictor variables were the IRM grade, measuring the severity of downward displacement of the IRM relative to the level of the fracture's edge (mild [grade I], moderate [grade II], or severe [grade III]), and fracture size. The primary outcome was surgical repair. The secondary outcomes were post-trauma diplopia (at baseline and at 10 days) and persistent annoying diplopia and/or enophthalmos considered independently or as a composite outcome. Other study variables included demographic and injury-related parameters. Descriptive, bivariate, and multiple logistic regression statistics were computed, and the significance level was set at P #.05. Results: The sample was composed of 108 patients with a mean age of 46.8 AE 23 years; 73.1% were men. The IRM grade was associated with surgical repair (P < .001), post-trauma diplopia (P < .001), and the composite outcome (P = .003). Fracture size was associated with enophthalmos (P = .03) and the composite outcome (P = .009). In the adjusted model, only IRM grades II and III were associated with the decision for surgical repair (P < .001). Conclusions: The results of this study suggest that the IRM grade, unlike fracture size, may be a valid measurement in surgical decision making, as well as in determining BOF severity, as evidenced by the correlation between the IRM grade and surgical repair, as well as clinical outcome.

Is Surgery Needed for Diplopia after Blowout Fractures? A Clarified Algorithm to Assist Decision-making

“…Generally, an orbital floor defect larger than 50% or 2 cm 2 is indicated for a surgical correction. 4 , 11 , 23 , 28 Additionally, an enophthalmos of more than 2 mm, which is commonly related to substantial herniated orbital tissues inferiorly after orbital floor fracture, is an indication for surgery. 4 , 21 , 23 However, diplopia may also gradually resolve after improvement of periorbital edema or swelling.…”

“…Gavin-Clavero et al 16 Retrospective study 28 Kohyama et al 50 Retrospective study 29 Alameddine et al 36 Retrospective study 30 Barh et al 17 Retrospective study 31 Seen et al 51 Retrospective study 32 Ordon et al 21 Retrospective study 33 Saha et al 48 Prospective cohort study 34 Alafaleq et al 22 Retrospective study 35 Hsu et al 23 Retrospective study 36 Hartwig et al 10 Retrospective study 37 Su et al 15 Retrospective study 38 Bianchi et al 32 Prospective cohort study 39 Homer et al 4 Review - 40 Balaji et al 31 Retrospective study 41 Tsumiyama et al 52 Prospective cohort study 42 Scolozzi et al 28 Prospective cohort study 43 Jazayeri et al 20 Review - 44 Pankratov et al 25 Retrospective study…”

“…Although diplopia may gradually resolve after the improvement of periorbital edema or swelling in some patients, most surgeons verify either the presence of an orbital floor defect larger than 50% or 2 cm 2 or an enophthalmos greater than 2 mm to be indicated for a surgical correction. 4 , 11 , 23 , 28 …”

“…Although diplopia may gradually resolve after the improvement of periorbital edema or swelling in some patients, most surgeons verify either the presence of an orbital floor defect larger than 50% or 2 cm 2 or an enophthalmos greater than 2 mm to be indicated for a surgical correction. 4,11,23,28 Enophthalmos and change of eyeball position might not occur prominently in the first few weeks after trauma due to the increased volume in the injured orbital cavity. 15,20 This is the reason why the motility of the injured orbit is checked first rather than position in our proposed algorithm.…”

Comparison of the Fractured and Non-Fractured Orbit Before and After Surgery Using a Titanium Implant or a Resorbable Poly-d,l-lactic Acid (PDLLA) Implant: A Study from a Single Center in Niš, Serbia of 58 Patients with Unilateral Orbital Floor Fracture Using Volumetric Measurement

“…However, measurement methods and fracture types vary. Numerous studies have focused on changes in orbital volume [ 16 , 17 ]. Enophthalmos associated with orbital floor fracture is the result of various factors, among which the increase in orbital volume is considered the most common factor, and there are numerous studies that have attempted to evaluate the success of surgical reconstruction by measuring orbital volume [ 18 ].…”