Orbital roof fractures as an indicator for concomitant ocular injury
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Orbital roof fractures are a significant cause of morbidity in trauma and are associated with a spectrum of orbital and ocular injuries. This study aims to characterize orbital roof fracture patterns and quantify the rate of acute intervention as compared with non-roof involving orbital wall fractures.
This study is a retrospective analysis of 340 orbital wall fractures diagnosed by CT imaging from August 2015 to October 2016. Orbital wall fractures were categorized as roof involving (N = 50) and non-roof involving (N = 290). Comparisons were made between these two groups to indicate a statistically significant difference in mechanism of injury, subjective symptoms, CT and exam findings, and final plan of care to include acute ophthalmologic intervention at the time of consultation.
Assault (40.7%) was the most common cause of non-roof-involving fractures while falls from height (20.0%) were associated with a higher rate of roof fractures. Roof-involving orbital wall fractures were associated with a higher prevalence of corneal abrasions (16.3%), lid lacerations (23.4%), and traumatic optic neuropathy (10.4%). A reliable subjective exam on initial ophthalmic consultation was not achieved in a larger proportion of roof fracture patients (30%). Despite this, the rate of acute intervention in this group (34%) was almost double, including lateral canthotomy and cantholysis.
Concomitant ocular injury is common in roof-involving orbital wall fractures, and may require more urgent ophthalmologic evaluation and acute intervention. As subjective patient data is often less readily available, a high index of suspicion and thorough investigation is warranted in caring for patients with roof-involving orbital wall fractures.
KeywordsEye injuries Orbital fractures Trauma centers Wounds and injuries
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the office of the Institutional Review Board (IRB), Department of Clinical Investigations at BAMC, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The study was granted a waiver of informed consent by the IRB board at BAMC as it involved no more than minimal risk to the individuals and their privacy. The data is Health Insurance Portability and Accountability Act (HIPAA) compliant. Demographic and clinical data from the initial examination, surgical charts, and follow-up visits were recorded in a de-identified database.
The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of San Antonio Military Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.
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