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Lily V Saadat, Elizabeth Chiang, Jared A Spitz, Paul Bryar, Dustin French, Christopher B Chambers; Orbital Fractures: Patient Demographics, Etiology and Clinical Presentation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5488.
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Orbital fractures remain a common cause of ophthalmology consults and surgical intervention across all age groups. Our study evaluated demographics and injury characteristics for all patients presenting with orbital fractures at Northwestern Memorial Hospital, a level 1 trauma center.
We retrospectively reviewed all patients using ICD9 codes for facial fractures or CPT codes for orbital fracture repair at Northwestern Memorial Hospital between January 2005 and October 2012. The medical records were reviewed for demographic data, cause of injury, fracture type, evidence of entrapment, and intoxication status.
412 patients were identified. Of these patients, 143 were under 30 years of age (34.7%); 155 were between 30-49 years (37.6%); 81 were between 50-69 (19.7%); 7 were between 70-74 (1.7%); and 26 were 75 or older (6.3%). Mean patient age was 40 years. The majority of patients were Caucasian (56.3%), with African American being the second most common group in every age bracket (22.8%). In the under 30 cohort, the majority of fractures were caused by assault (52.4%), followed by sports injury (18.2%). The 30-49 group was similar, with assault responsible for 65 fractures (41.9%), followed by sports injury (22.6%). Most fractures between 50-69 were caused by falls (50.6%), followed by assault (20.5%). Two patients in the 50-69 cohort had two incidences of acute orbital fracture. Falls were responsible for most cases in the 70-74 cohort (71.4%) as well as the 75+ group (88.5%). Across all age groups, the majority of patients presented with multiple facial fractures and involvement of only one orbit. Entrapment was noted in 26 patients under 30 (18.2%); 35 patients aged 30-49 (22.6%); 13 patients aged 50-69 (16.1%); and 2 patients above 75 (7.7%). Intoxication with drugs and/or alcohol at the time of fracture was most common in the under 30 group (39.2%).
Understanding the clinical presentation of patients with orbital fractures can guide treatment and preventive measures used during physical activity. Orbital fractures from blunt trauma are more likely due to assault in younger populations and falls in older age groups. Alcohol and drug intoxication at the time of fracture is also more common among younger patients. Despite these variances in patient characteristics, fracture type and severity was not significantly different based on injury etiology.
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