Delayed surgical treatment of orbital trapdoor fracture in paediatric patients

Su, Yishi; Shen, Qin; Bi, Xiaoping; Lin, Ming Fong; Fan, Xianqun

doi:10.1136/bjophthalmol-2018-311954

Cited by 22 publications

(31 citation statements)

References 23 publications

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“…17,18 It should be noted, however, that while entrapment requires urgent surgery preferably within 48 hours, diplopia due to impingement is not an ophthalmologic emergency and surgery should be deferred until it can be performed by an adept surgeon. 19,20 In this study, we found vision-threatening injuries to account for 11.9% of all ocular injuries that presented to the ED. Of these major injuries, posterior segment findings such as retinal tear or choroidal rupture encompassed a small percentage (1.3%) of all injuries.…”

Section: Discussionmentioning

confidence: 65%

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<p>Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis</p>

Terrill¹,

You²,

Eiseman³

et al. 2020

OPTH

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a level-one trauma center, to help determine the most appropriate setting for the initial dilated fundus examination by ophthalmologists. Methods: A retrospective study was performed from January 2008 to January 2013 of patients diagnosed with orbital wall fracture secondary to trauma. Exclusion criteria included unknown mechanism of injury, the absence of ophthalmology consultation, or absence of imaging. Data collected included age, gender, mechanism of injury, visual acuity, and anterior/ posterior segment findings. Ocular injuries were categorized as either minor or major. Results: Of 567 charts reviewed, 460 met criteria and were included for analysis. In the analysis, 86.5% of patients were male, and 81.3% were Caucasian. The most common mechanism of orbital fracture was blunt injury. Visual acuity was better than 20/100 in 82.4% of patients. On chart review, 81.1% of patients were found to have either a minor injury, a major injury, or both. The most common injury was subconjunctival hemorrhage (53.5%). Globe rupture (2.9%) and vision-threatening posterior segment findings such as retinal tear and choroidal rupture (1.3%) were relatively rare. Only one retinal detachment (0.2%) was found, specifically in the setting of severe injury with concomitant globe rupture. Conclusion: Knowledge of the common ocular injuries associated with orbital fractures will help emergency department (ED) physicians and ophthalmologists provide the dilated fundus exam in the most appropriate setting. The most frequent injuries identified were non-vision threatening, and visually significant posterior segment findings were relatively rare (1.3%). Thus, for the majority of patients presenting to the ED with orbital fracture, a dilated fundus exam can be performed at a later date in the outpatient clinic setting, unless urgent orbital fracture surgery is planned.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

<p>Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis</p>

Terrill¹,

You²,

Eiseman³

et al. 2020

OPTH

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“…Some children have already been "delayed" when they are referred. 18 We suggest having surgical reduction of inferior tissue entrapment within 10 days, post orbital trapdoor fractures. We believe it would bring out better outcomes on motility and result in less diplopia.…”

Section: Discussionmentioning

confidence: 96%

Factors Influencing Surgical Outcomes in Orbital Trapdoor Fracture

Chen

Tsai

Tseng

2021

Preprint

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This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post- operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p=0.02), muscle incarceration (p=0.01), duration from injury to surgical reduction (p=0.004), and postoperative supra-duction limitation (p=0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.

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“…Consequently, trapdoor fracture is one of the rare facial fractures requiring emergency surgery [ 28 ]. In instances of extraocular muscle entrapment, it is best to perform surgery within 48 h. Delayed surgical treatment may lead to the longer recovery time and worsen the prognosis [ 29 ].…”

Section: Outcomes and Discussionmentioning

confidence: 99%

Theoretical model of pediatric orbital trapdoor fractures and provisional personalized 3D printing-assisted surgical solution

Chai

Zhang

Hua

et al. 2021

Bioactive Materials

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Pediatric orbital trapdoor fractures are common in children and adolescents and usually require emergency surgical intervention. Herein, a personalized 3D printing-assisted approach to surgical treatment is proposed, serving to accurately and effectively repair pediatric orbital trapdoor fractures. We first investigated stress distribution in external force-induced orbital blowout fractures via numerical simulation, determining that maximum stresses on inferior and medial walls exceed those on superior and lateral walls and thus confer higher probability of fracture. We also examined 36 pediatric patients treated for orbital trapdoor fractures between 2014 and 2019 to verify our theoretical construct. Using 3D printing technique, we then created orbital models based on computed tomography (CT) studies of these patients. Absorbable implants were tailor-made, replicating those of 3D-printed models during surgical repairs of fractured orbital bones. As follow-up, we compared CT images and clinical parameters (extraocular movements, diplopia, enophthalmos) before and 12 months after operative procedures. There were only two patients with diplopia and six with enophthalmos >2 mm at 12 months, attesting to the efficacy of our novel 3D printing-assisted strategy.

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Delayed surgical treatment of orbital trapdoor fracture in paediatric patients

Cited by 22 publications

References 23 publications

<p>Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis</p>

<p>Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis</p>

Factors Influencing Surgical Outcomes in Orbital Trapdoor Fracture

Theoretical model of pediatric orbital trapdoor fractures and provisional personalized 3D printing-assisted surgical solution

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