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Dinesh Gunasekeran, Petrina Tan, E-Shawn Goh; Evaluation and management outcomes of orbital wall fractures presenting to a tertiary hospital in Singapore.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2785.
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To identify patient demographics, clinical characteristics, sensitivity of X-ray in fracture diagnosis, and management outcomes of orbital wall fractures in a Singapore tertiary hospital.
Retrospective review of all patients with blunt orbital trauma who attended the outpatient ophthalmology service between Jan 2010 - Dec 2011.
68/329 patients presenting with blunt orbital trauma underwent CT scan. 45/68 patients had radiological evidence of orbital wall fracture. They were predominantly middle-aged (52.5 years, range 18 - 97) men (64.7%) with documented etiology of falls (51.1%), assault (44.4%) and road traffic accidents (4.44%). Clinical features suggestive of orbital wall fracture at presentation and 1 week examination respectively, include binocular diplopia (PPV = 70.5% and 100%), step deformity (PPV = 75% and 100%), infraorbital paraesthesiae (PPV = 76.9% and 100%), and ocular motility restriction (PPV = 79.2% and 100%). The sensitivity of orbital X-rays in detecting fracture was 25.6%, and the specificity was 82.6%. 11/45 of fracture patients underwent operative repair. At 1 month follow-up, they had complete resolution of symptoms except for 1 patient with residual motility restriction. 34/45 of fracture patients were observed and experienced a higher incidence of residual symptoms at 1 month (5 patients), including motility restriction (2) and persistent infra-orbital paraesthesiae (3).
Orbit X-rays have a high specificity for excluding fractures. If the clinical suspicion exists, CT of the orbits should be performed without delay of X-rays. Open reduction / fixation of large fractures in symptomatic patients has equivalent or better outcomes at 1 month compared to the natural history of fractures managed conservatively.
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